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General NPI Number Information
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NPI Number | 1659594992
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Entity Type | Organization
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Legal Business Name | BREIWA, WARE & JESKIE PSC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 10/31/2014
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Provider Practice Location Address
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Address Line | 390 OLD GALLATIN RD
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City | SCOTTSVILLE
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State | KY
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Zip | 42164-8954
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Country | US
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Telephone | 270-237-5434
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Fax | 270-237-3529
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Provider Business Mailing Address
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Address Line | P.O. BOX 480 390 OLD GALLATIN RD
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City | SCOTTSVILLE
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State | KY
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Zip | 42164-8954
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Country | US
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Telephone | 270-237-5434
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Fax | 270-237-3529
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. JOHN W JESKIE
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Credential | OD
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Telephone | 270-237-5434
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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 |
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License Number State |
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