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General NPI Number Information
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NPI Number | 1679745756
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Entity Type | Organization
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Legal Business Name | KENTUCKY OPTICAL EXPRESS, INC.
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Dates
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Enumeration Date | 03/28/2008
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Last Update Date | 03/19/2009
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Provider Practice Location Address
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Address Line | 122 STONE TRACE DRIVE SUITE B
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City | MOUNT STERLING
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State | KY
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Zip | 40353
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Country | US
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Telephone | 888-497-2117
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Fax | 859-497-2542
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Provider Business Mailing Address
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Address Line | 122 STONE TRACE DR. SUITE B
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City | MOUNT STERLING
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State | KY
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Zip | 40353-5242
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Country | US
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Telephone | 888-497-2117
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Fax | 859-497-2542
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. WALLACE BULLARD GUERRANT JR.
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Credential | O.D.
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Telephone | 888-497-2117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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