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General NPI Number Information
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NPI Number | 1821812645
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Entity Type | Organization
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Legal Business Name | MOONEY EYECARE CENTRE, PLLC
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Dates
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Enumeration Date | 11/08/2024
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 6287 TAYLORSVILLE RD STE 2
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City | FISHERVILLE
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State | KY
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Zip | 40023-7410
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Country | US
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Telephone | 502-538-4362
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Fax |
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Provider Business Mailing Address
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Address Line | 327 EASTBROOKE POINTE DR STE 100
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City | MOUNT WASHINGTON
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State | KY
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Zip | 40047-5577
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Country | US
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Telephone | 502-538-4362
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | MATTHEW LUTES MOONEY
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Credential | OD
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Telephone | 502-538-4362
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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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