Provider Demographics
NPI:1851384960
Name:EYECARE CENTER OPTOMETRIST PSC
Entity type:Organization
Organization Name:EYECARE CENTER OPTOMETRIST PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-623-3358
Mailing Address - Street 1:1020 GIBSON BAY DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3448
Mailing Address - Country:US
Mailing Address - Phone:859-623-3358
Mailing Address - Fax:859-623-8141
Practice Address - Street 1:1020 GIBSON BAY DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3448
Practice Address - Country:US
Practice Address - Phone:859-623-3358
Practice Address - Fax:859-623-8141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77902518Medicaid
KY77902518Medicaid
KY3718Medicare PIN