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NPI Code Detail

MEDICARE: MY VISION CARE PROFESSIONAL LIMITED LIABILITY COMPANY

MEDICARE: MY VISION CARE PROFESSIONAL LIMITED LIABILITY COMPANY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist

General Provider Information

NPI Number : 1144060815
Entity Type Code : Organization
Provider Name (Legal Business Name) : MY VISION CARE PROFESSIONAL LIMITED LIABILITY COMPANY
Provider Business Mailing Address
First Line : 114 E REYNOLDS RD
Second Line :
City : LEXINGTON
State : KY
Zip : 40517-1248
Country : US
Telephone Number : 832-722-0193
Fax Number :
Provider Business Practice Location Address
First Line : 114 E REYNOLDS RD
Second Line :
City : LEXINGTON
State : KY
Zip : 40517-1248
Country : US
Telephone Number : 832-722-0193
Fax Number :
Authorized Official
Title or Position : ADMIN
Name : RON HADDAD
Credential :
Telephone Number : 832-722-0193
Provider Enumeration Date : 05/29/2024
Last Update Date : 10/24/2024

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Directions to “MY VISION CARE PROFESSIONAL LIMITED LIABILITY COMPANY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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