=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699924167
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISION CARE PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2008
-----------------------------------------------------
Last Update Date | 12/01/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 78 BARNES DR
-----------------------------------------------------
City | MONTICELLO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42633-9002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-348-3355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 78 BARNES DR
-----------------------------------------------------
City | MONTICELLO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42633-9002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-348-3355
-----------------------------------------------------
Fax | 606-348-5665
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. MATT J HESSE
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 606-348-3355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | KY1512
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------