Provider Demographics
NPI:1699753673
Name:EMMICK, ROSEMARY (OPTOMETRIST)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:EMMICK
Suffix:
Gender:F
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 EASTWIND COURT
Mailing Address - Street 2:
Mailing Address - City:HAWESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42348
Mailing Address - Country:US
Mailing Address - Phone:270-927-8700
Mailing Address - Fax:270-927-0837
Practice Address - Street 1:123 EASTWIND COURT
Practice Address - Street 2:
Practice Address - City:HAWESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42348
Practice Address - Country:US
Practice Address - Phone:270-927-8700
Practice Address - Fax:270-927-0837
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1064 DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77010643Medicaid
KYT54735Medicare UPIN
KY9355401Medicare PIN
KY77010643Medicaid