Provider Demographics
NPI:1699924167
Name:VISION CARE PSC
Entity type:Organization
Organization Name:VISION CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:J
Authorized Official - Last Name:HESSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-348-3355
Mailing Address - Street 1:78 BARNES DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-9002
Mailing Address - Country:US
Mailing Address - Phone:606-348-3355
Mailing Address - Fax:606-348-5665
Practice Address - Street 1:78 BARNES DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-9002
Practice Address - Country:US
Practice Address - Phone:606-348-3355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1512152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4310630001Medicare NSC