Edmonton Family Vision Center PSC
Organization Active NPI Optometrist · Edmonton, KY
NPI 1275712416 · NPPES record last updated Feb 20, 2017
Key facts
- NPI
- 1275712416
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 1226DT (KY)
- Legal business name
- EDMONTON FAMILY VISION CENTER PSC
- Practice address
- 1406 W Stockton St
Edmonton, KY 42129-8125 - Phone
- (270) 432-0123
- Fax
- (270) 432-5899
- NPI assigned
- Oct 24, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Robert N Whitlow II, O.D.
- Title
- Ceo
- Phone
- (270) 432-0123
Practitioners 4
-
Ronald T. Wagner, O. D.
-
Cheryl Gilchrist Whitlow, O.D.
-
Robert N Whitlow II, O.D.
-
Allison J Kerr, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040901000133 | KY | Part B Supplier - Clinic/Group Practice | 0042285108 |
Receives reassigned benefits from 3 practitioners Practice locations: Edmonton, KY |
National Provider Directory
Locations
1406 W Stockton St
Edmonton, KY 42129
Phone (270) 432-0123
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 1226DT | KY | Yes |
Addresses
Primary practice location
1406 W Stockton St
Edmonton, KY 42129-8125
Mailing address
1406 W Stockton St
Edmonton, KY 42129-8125
Phone (270) 432-0123
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 77903250 | Medicaid | KY |
Other providers in Edmonton, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.