Active NPI
Eyecare Center Optometrist PSC
- Optometrist
- Georgetown, KY
National Provider Identifier
1619163169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1069DT
- Legal business name
- EYECARE CENTER OPTOMETRIST PSC
- Practice address
- 201 Champion Way
Ste 1
Georgetown, KY 40324-8828 - Phone
- (502) 863-2020
- Fax
- (502) 867-4938
- NPI assigned
- Sep 19, 2007
- Last updated
- Nov 12, 2008
- Organization subpart
- Yes
- Parent organization
- EYE CARE CENTER OPTOMETRIST PSC
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
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1069DT | KY | Primary |
Addresses
Primary practice location
201 Champion Way
Ste 1
Georgetown, KY 40324-8828
Mailing address
1020 Gibson Bay Dr
Richmond, KY 40475-3448
Phone (859) 623-3358
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 Directory- Part of
- Eyecare Center Optometrist PSC
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Optometrist
- Richmond, KY
- NPI 1174516298
NPI 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": "1226448000000",
"number": "1619163169",
"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": "859-623-3358"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 CHAMPION WAY",
"address_2": "STE 1",
"city": "GEORGETOWN",
"state": "KY",
"postal_code": "403248828",
"telephone_number": "502-863-2020",
"fax_number": "502-867-4938"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EYECARE CENTER OPTOMETRIST PSC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "EYE CARE CENTER OPTOMETRIST PSC",
"enumeration_date": "2007-09-19",
"last_updated": "2008-11-12",
"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": "",
"desc": "Optometrist",
"state": "KY",
"license": "1069DT",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Georgetown, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 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.