Crockett Family Vision Center

Primary specialty

OptometristTaxonomy code 152W00000X

License

1342DT Issued in KY

Legal business name

CROCKETT FAMILY VISION CENTER

Practice address

25 Sterling Way Ste C
Mt Sterling, KY 40353-1174

Phone

(859) 498-4800

NPI assigned

Oct 26, 2009

Organization subpart

No

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

Authorized official

Name

Ryan Crockett

Title

Owner

Phone

(859) 498-4800

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1256515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256515200000",
    "number": "1871829945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 STERLING WAY STE C",
            "city": "MT STERLING",
            "state": "KY",
            "postal_code": "403531174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 STERLING WAY STE C",
            "city": "MT STERLING",
            "state": "KY",
            "postal_code": "403531174",
            "telephone_number": "859-498-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROCKETT FAMILY VISION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-26",
        "last_updated": "2009-10-26",
        "status": "A",
        "authorized_official_last_name": "CROCKETT",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "859-498-4800"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1342DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000062161",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77013423",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Mt Sterling, KY
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• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2009; 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.