Corbin Optical Co Inc

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

567 Issued in KY

Legal business name

CORBIN OPTICAL CO INC

Practice address

107 Kentucky Street
Corbin, KY 40701

Phone

(606) 528-2833

Fax

(606) 528-2862

NPI assigned

Jan 29, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Larry Thomas Tate, OPTICIANNPI 1336559186

Title

President Corbin Optical

Phone

(606) 528-2833

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Larry Tate, LDO

  • Optician
  • Corbin, KY
  • NPI 1336559186
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1164568028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 420",
            "address_2": "107 N. KENTUCKY AVE.",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407020420",
            "telephone_number": "606-528-2833",
            "fax_number": "606-528-2862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 KENTUCKY STREET",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "40701",
            "telephone_number": "606-528-2833",
            "fax_number": "606-528-2862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORBIN OPTICAL CO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "TATE",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT CORBIN OPTICAL",
        "authorized_official_telephone_number": "606-528-2833",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OPTICIAN"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "KY",
            "license": "567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "52905676",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Eyewear Supplier in Corbin, KY
• Providers in Corbin, KY by specialty
• Eyewear Supplier in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.