Provider Demographics
NPI:1306990510
Name:LOVE AND WARDEN EYE CARE, PLLC
Entity type:Organization
Organization Name:LOVE AND WARDEN EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:WARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-796-6021
Mailing Address - Street 1:1945 SCOTTSVILLE RD STE B2
Mailing Address - Street 2:PMB 239
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-5836
Mailing Address - Country:US
Mailing Address - Phone:270-796-6021
Mailing Address - Fax:270-796-6072
Practice Address - Street 1:1256 CAMPBELL LN
Practice Address - Street 2:SUITE 106
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1082
Practice Address - Country:US
Practice Address - Phone:270-796-6021
Practice Address - Fax:270-796-6072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYDE7292OtherRAILROAD MEDICARE GROUP
KY77903854Medicaid
KY5311190001Medicare NSC
KY9357Medicare PIN