Provider Demographics
NPI:1386909018
Name:E TOWN EYECARE PSC
Entity type:Organization
Organization Name:E TOWN EYECARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KREIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-747-7688
Mailing Address - Street 1:103 DIECKS DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2444
Mailing Address - Country:US
Mailing Address - Phone:270-769-1397
Mailing Address - Fax:270-765-4899
Practice Address - Street 1:103 DIECKS DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2444
Practice Address - Country:US
Practice Address - Phone:270-769-1397
Practice Address - Fax:270-765-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1880DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK053470Medicare PIN