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General NPI Number Information
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NPI Number | 1922814243
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Entity Type | Organization
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Legal Business Name | SAGE PEAK EYE CARE PLLC
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 1407 N RACE ST
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City | GLASGOW
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State | KY
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Zip | 42141-3490
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Country | US
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Telephone | 270-651-6652
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Fax |
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Provider Business Mailing Address
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Address Line | 1407 N RACE ST
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City | GLASGOW
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State | KY
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Zip | 42141-3490
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAE WILSON
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Credential | OD
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Telephone | 270-651-6652
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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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