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General NPI Number Information
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NPI Number | 1659564706
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Entity Type | Organization
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Legal Business Name | MURRAY VISION CENTER LLC
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 106 N 6TH ST
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City | MURRAY
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State | KY
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Zip | 42071-2015
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Country | US
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Telephone | 270-753-2842
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Fax |
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Provider Business Mailing Address
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Address Line | 106 N 6TH ST
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City | MURRAY
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State | KY
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Zip | 42071-2015
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | JAMES DAVID JACO
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Credential | O.D.
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Telephone | 270-753-2842
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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 | 1768DT
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License Number State | KY
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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 | 1292DT
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License Number State | KY
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