=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730422353
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KERR EYE CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2013
-----------------------------------------------------
Last Update Date | 06/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2988 BURKESVILLE RD SUITE 160
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42728-5534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-384-4444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2988 BURKESVILLE RD SUITE 160
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42728-5534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-384-4444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPTOMETRIST
-----------------------------------------------------
Name | ALLISON KERR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-881-1402
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1869 DT
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------