PCD Management of Paducah, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

PCD MANAGEMENT OF PADUCAH, LLC

Practice address

467 Jordan Drive
Suite 101
Paducah, KY 42001

Phone

(270) 297-2020

NPI assigned

Jun 26, 2020

Organization subpart

No

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

Authorized official

Name

Caleb Tanck

Title

Credentialing Agent

Phone

(539) 476-2015

Specialties & licenses 2

Addresses

Other names 2

• PCD Management of Paducah Doing business as
• Success Vision Eyecare of Paducah, LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Locations

Practitioners 4

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

• Kenneth Hall, OD

  • Optometrist
  • Louisville, KY
  • NPI 1124025853
  Medicare reassignment Care Compare group NPD
• Theodore K. Sullivan, O.D.

  • Optometrist
  • Saint Louis, MO
  • NPI 1437153772

  KY

  Medicare reassignment Care Compare group NPD
• Bryan Wesley Wood, O.D.

  • Optometrist
  • Cape Girardeau, MO
  • NPI 1275648677

  KY

  Medicare reassignment Care Compare group NPD
• Geoffrey Bryan Wood, OD

  • Optometrist
  • Cape Girardeau, MO
  • NPI 1013754472

  KY

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1593129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761091200000",
    "number": "1659998524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5312 W 41ST ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741076110",
            "telephone_number": "918-895-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "467 JORDAN DRIVE",
            "address_2": "SUITE 101",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "42001",
            "telephone_number": "270-297-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PCD MANAGEMENT OF PADUCAH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-26",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A",
        "authorized_official_last_name": "TANCK",
        "authorized_official_first_name": "CALEB",
        "authorized_official_title_or_position": "CREDENTIALING AGENT",
        "authorized_official_telephone_number": "539-476-2015"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PCD Management of Paducah",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Success Vision Eyecare of Paducah, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Jacquelynn Patterson
• Kevin Ray Patterson
• Jason Gregory Patton, M.D.
• Alexa T Payne
• Penny Rae Payne, PA
• Emma Victoria Peal
• Megan Elizabeth Peck
• Pediatric Group of Paducah
• Pediatric Rehab
• Rolanda Sue Peek-Fisk, LCSW

• Optometrist in Paducah, KY
• Providers in Paducah, KY by specialty
• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2025; 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.