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General NPI Number Information
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NPI Number | 1649431560
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Entity Type | Organization
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Legal Business Name | BROADWAY EYE CARE ASSOCIATES, PSC
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 2600 W BROADWAY STE 105
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City | LOUISVILLE
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State | KY
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Zip | 40211-1303
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Country | US
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Telephone | 502-772-3625
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Fax | 502-772-3037
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Provider Business Mailing Address
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Address Line | PO BOX 11744
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City | LOUISVILLE
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State | KY
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Zip | 40251-0744
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Country | US
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Telephone | 502-772-3625
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Fax | 502-772-3037
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | DR. SHORYE PAYNE
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Credential | M.D.
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Telephone | 502-772-3625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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