Southern Kentucky Eye Center PSC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

SOUTHERN KENTUCKY EYE CENTER PSC

Practice address

120 Tradepark Dr
Suite a
Somerset, KY 42503-3454

Phone

(606) 679-7778

Fax

(606) 451-1814

NPI assigned

Feb 13, 2007

Organization subpart

No

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

Authorized official

Name

Terri Coomer

Title

Billing Dept Manager

Phone

(606) 679-5837

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Locations

Practitioners 2

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

• Kathryn T. Wilson, DO

  • Optometrist
  • Somerset, KY
  • NPI 1851777825
  Medicare reassignment Care Compare group NPD
• Mark A Henry, MD

  • Ophthalmology Physician
  • Somerset, KY
  • NPI 1972587251
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563235200000",
    "number": "1285776476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 TRADEPARK DR",
            "address_2": "SUITE A",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425033454",
            "telephone_number": "606-679-7778",
            "fax_number": "606-451-1814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 TRADEPARK DR",
            "address_2": "SUITE A",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "425033454",
            "telephone_number": "606-679-7778",
            "fax_number": "606-451-1814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN KENTUCKY EYE CENTER PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2019-07-16",
        "status": "A",
        "authorized_official_last_name": "COOMER",
        "authorized_official_first_name": "TERRI",
        "authorized_official_title_or_position": "BILLING DEPT MANAGER",
        "authorized_official_telephone_number": "606-679-5837"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "3061400",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4020794",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA",
            "identifier": "1520956",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65928939",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUE SHIELD",
            "identifier": "000000041743",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "180028760",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Somerwoods SNF Operations LLC
• Angela Marie Souders, TCADC
• Southeast Kentucky Clinic
• Southeastern Medical Supply LLC
• Southern Hearing Aid, Inc.
• Southern Kentucky Therapy LLC
• Southern Kentucky Vascular ASC PLLC
• Southern Kentucky Vascular Clinic PLLC
• Southern Kentucky Vascular Procedure Center, PLLC
• Southern Travel Surgery PLLC

• Ophthalmology Physician in Somerset, KY
• Providers in Somerset, KY by specialty
• Ophthalmology Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.