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NPI Code Detail

MEDICARE: SCK VISION CARE, PSC

MEDICARE: SCK VISION CARE, PSC
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
1152W00000XOptometrist1461DTKY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922428325
Entity Type Code : Organization
Provider Name (Legal Business Name) : SCK VISION CARE, PSC
Provider Business Mailing Address
First Line : 2345 HAPPY VALLEY RD
Second Line :
City : GLASGOW
State : KY
Zip : 42141-8076
Country : US
Telephone Number : 270-678-4338
Fax Number :
Provider Business Practice Location Address
First Line : 2345 HAPPY VALLEY RD
Second Line :
City : GLASGOW
State : KY
Zip : 42141-8076
Country : US
Telephone Number : 270-678-4338
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. JARROD MAYHEW
Credential : O.D.
Telephone Number : 270-678-4338
Provider Enumeration Date : 04/24/2014
Last Update Date : 04/24/2014

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