Provider Demographics
NPI:1194790352
Name:TUCKER, DAVID N (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:N
Last Name:TUCKER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7009
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-7009
Mailing Address - Country:US
Mailing Address - Phone:270-443-9955
Mailing Address - Fax:270-442-1469
Practice Address - Street 1:1748 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-2706
Practice Address - Country:US
Practice Address - Phone:270-443-9955
Practice Address - Fax:270-442-1469
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY937DT152W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5789371OtherAETNA
KY000000050469OtherBLUE CROSS BLUE SHIELD
KYY54702OtherBLUEGRASS FAMILY HEALTH
KY390982OtherHEALTHLINK
KY77009371Medicaid
KY77009371Medicaid
KY390982OtherHEALTHLINK
KY5789371OtherAETNA
KY0274390003Medicare NSC