Provider Demographics
NPI:1891994455
Name:DR. TAMMY G. HOSKINS OPTOMETRY PSC
Entity type:Organization
Organization Name:DR. TAMMY G. HOSKINS OPTOMETRY PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:GWYN
Authorized Official - Last Name:HOSKINS
Authorized Official - Suffix:
Authorized Official - Credentials:OPTOMETRIST
Authorized Official - Phone:859-734-3155
Mailing Address - Street 1:HARRODSBURG EYE CENTER
Mailing Address - Street 2:201 S MAIN ST
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330
Mailing Address - Country:US
Mailing Address - Phone:859-734-3155
Mailing Address - Fax:
Practice Address - Street 1:HARRODSBURG EYE CENTER
Practice Address - Street 2:201 S MAIN ST
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330
Practice Address - Country:US
Practice Address - Phone:859-734-3155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1205DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77904050Medicaid
KY77904050Medicaid