Bowersox Vision Center PSC
Organization Active NPI Optometrist · Shelbyville, KY
NPI 1720115702 · NPPES record last updated Jan 22, 2025
Key facts
- NPI
- 1720115702
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 1301DT (KY)
- Legal business name
- BOWERSOX VISION CENTER PSC
- Practice address
- 403 Washington St
Shelbyville, KY 40065-1127 - Phone
- (502) 647-3937
- Fax
- (502) 633-7326
- NPI assigned
- Feb 27, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Daniel M Bowersox, OD
- Title
- Optometrist
- Phone
- (502) 647-3937
Practitioners 9
-
Daniel Mark Bowersox, O.D.
-
Troy A Moats, O.D.
-
Stuart Boyd Young, O.D.
-
Karoline L Munson, O. D.
-
Amber McIntosh, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050726000076 | KY | Part B Supplier - Clinic/Group Practice | 4789611336 |
Receives reassigned benefits from 7 practitioners Practice locations: Louisville, KY; Shelbyville, KY |
National Provider Directory
Locations
833 E Main St
Frankfort, KY 40601
Phone (502) 227-4508
3701 Hopewell Rd
Louisville, KY 40299
Phone (502) 266-5661
517 Washington St
Shelbyville, KY 40065
Phone (502) 633-0120
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 1301DT | KY | Yes |
Addresses
Primary practice location
403 Washington St
Shelbyville, KY 40065-1127
Mailing address
403 Washington St
Shelbyville, KY 40065-1127
Phone (502) 647-3937
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 77013019 | Medicaid | KY |
Other providers in Shelbyville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2025. 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.