Provider Demographics
NPI:1285776476
Name:SOUTHERN KENTUCKY EYE CENTER PSC
Entity type:Organization
Organization Name:SOUTHERN KENTUCKY EYE CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:COOMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-679-5837
Mailing Address - Street 1:120 TRADEPARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3454
Mailing Address - Country:US
Mailing Address - Phone:606-679-7778
Mailing Address - Fax:606-451-1814
Practice Address - Street 1:120 TRADEPARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3454
Practice Address - Country:US
Practice Address - Phone:606-679-7778
Practice Address - Fax:606-451-1814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3061400OtherBCBS
TN4020794Medicaid
KY1520956OtherUMWA
KY65928939Medicaid
KY000000041743OtherBLUECROSS BLUE SHIELD
180028760OtherRAILROAD MEDICARE
180028760OtherRAILROAD MEDICARE
E67778Medicare UPIN