Provider Demographics
NPI:1427054949
Name:OVERLEY, ERIC TODD (OD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:TODD
Last Name:OVERLEY
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 306
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:KY
Mailing Address - Zip Code:42533-0306
Mailing Address - Country:US
Mailing Address - Phone:606-492-2211
Mailing Address - Fax:606-676-0873
Practice Address - Street 1:207 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1121
Practice Address - Country:US
Practice Address - Phone:606-549-0464
Practice Address - Fax:606-549-0438
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1290DT152W00000X
TN1614152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100209950Medicaid
TN3074226OtherBCBSTN/BLUECARE/TENNCARE
KY410027774OtherRAILROAD MEDICARE
KY4602OtherAVESIS/MEDICAID
KY7100210000Medicaid
01259225OtherAMERIGROUP
TN3061983OtherBCBSTN/BLUECARE/TENNCARE
KY77012904Medicaid
TN3073709OtherBCBSTN/BLUECARE/TENNCARE
TN3074226OtherBCBSTN/BLUECARE/TENNCARE
01259225OtherAMERIGROUP
TN3941099Medicaid
KY7100210000Medicaid
TN3061983OtherBCBSTN/BLUECARE/TENNCARE
KY7100209950Medicaid