Active NPI
Eyecare Center Optometrist PSC
- Optometrist
- Beattyville, KY
National Provider Identifier
1427244979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1069DT
- Legal business name
- EYECARE CENTER OPTOMETRIST PSC
- Practice address
- 1073 Broadway St
Beattyville, KY 41311-8719 - Phone
- (606) 464-8148
- Fax
- (606) 464-0142
- NPI assigned
- Sep 19, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. William T Reynolds Jr., OD
- Title
- Owner
- Phone
- (859) 623-3358
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1069DT | KY | Primary |
Addresses
Primary practice location
1073 Broadway St
Beattyville, KY 41311-8719
Mailing address
1020 Gibson Bay Dr
Richmond, KY 40475-3448
Phone (859) 623-3358
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 77902518 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031107000014 | KY | Part B Supplier - Clinic/Group Practice | 0143133058 |
Receives reassigned benefits from 8 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Beattyville, KY; Irvine, KY; Lexington, KY; MC Kee, KY; Richmond, KY |
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190160000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1226275200000",
"number": "1427244979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1020 GIBSON BAY DR",
"city": "RICHMOND",
"state": "KY",
"postal_code": "404753448",
"telephone_number": "859-623-3358",
"fax_number": "859-623-8141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1073 BROADWAY ST",
"city": "BEATTYVILLE",
"state": "KY",
"postal_code": "413118719",
"telephone_number": "606-464-8148",
"fax_number": "606-464-0142"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EYECARE CENTER OPTOMETRIST PSC",
"organizational_subpart": "NO",
"enumeration_date": "2007-09-19",
"last_updated": "2008-11-10",
"status": "A",
"authorized_official_last_name": "REYNOLDS",
"authorized_official_first_name": "WILLIAM",
"authorized_official_middle_name": "T",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "859-623-3358",
"authorized_official_name_prefix": "Dr.",
"authorized_official_name_suffix": "Jr.",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "KY",
"license": "1069DT",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "77902518",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beattyville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2008; 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.