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General NPI Number Information
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NPI Number | 1649968918
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Entity Type | Individual
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Provider Name | SAMUEL R CALVERT
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Gender | Male
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Dates
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Enumeration Date | 04/25/2023
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 335 NEW TOWNE DR
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City | BOWLING GREEN
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State | KY
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Zip | 42103-7966
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Country | US
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Telephone | 270-842-0383
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Fax |
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Provider Business Mailing Address
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Address Line | 335 NEW TOWNE DR
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City | BOWLING GREEN
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State | KY
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Zip | 42103-7966
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Country | US
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Telephone | 270-606-0269
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC6260
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2381DT
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License Number State | KY
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