Provider Demographics
NPI:1194973461
Name:THACKER, AMY ELIZABETH (OD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:ELIZABETH
Last Name:THACKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:499 INDIAN MOUND DR
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1096
Mailing Address - Country:US
Mailing Address - Phone:859-497-9382
Mailing Address - Fax:859-497-9387
Practice Address - Street 1:499 INDIAN MOUND DR
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1096
Practice Address - Country:US
Practice Address - Phone:859-497-9382
Practice Address - Fax:859-497-9387
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1605DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist