Southeastern Eye Care Clinic

Primary specialty

OptometristTaxonomy code 152W00000X

License

0902DT Issued in KY

Legal business name

SOUTHEASTERN EYE CARE CLINIC

Practice address

21937 Main St.
Hyden, KY 41749

Phone

(606) 672-2040

Fax

(606) 672-3937

NPI assigned

Jan 17, 2007

Last updated

Apr 2, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Carol Jo Holbrook

Title

Off MGR

Phone

(606) 672-2040

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Donald I Holbrook, OD

  • Optometrist
  • Hyden, KY
  • NPI 1376737320
  NPD (past)

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207094400000",
    "number": "1851443394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21937 MAIN STREET",
            "address_2": "PO DRW 778",
            "city": "HYDEN",
            "state": "KY",
            "postal_code": "417490778",
            "telephone_number": "606-672-2040",
            "fax_number": "606-672-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21937 MAIN ST.",
            "city": "HYDEN",
            "state": "KY",
            "postal_code": "41749",
            "telephone_number": "606-672-2040",
            "fax_number": "606-672-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN EYE CARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2008-04-02",
        "status": "A",
        "authorized_official_last_name": "HOLBROOK",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "OFF MGR",
        "authorized_official_telephone_number": "606-672-2040",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "0902DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77009025",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.