Gary V Hathcoat, OD

Individual provider Active NPI Optometrist · Mt Washington, KY

NPI 1891769345 · NPPES record last updated Apr 13, 2011

Key facts

NPI
1891769345
Entity type
Individual (NPI type 1)
Primary specialty
Optometrist 152W00000X
License
1204DT (KY)
Practice address
11102 Highway 44 East
Mt Washington, KY 40047-7211
Phone
(502) 904-9933
Fax
(502) 904-9935
NPI assigned
Feb 13, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
4901004469MIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
John Kenyon American Eye Institute LLC Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18002279 IN
Optometrist 152W00000X 1204DT KY Yes
Optometrist 152W00000X 4901004469 MI

Addresses

Primary practice location

11102 Highway 44 East
Mt Washington, KY 40047-7211

Mailing address

PO Box 1109
Mt Washington, KY 40047-1109
Phone (502) 904-9933

Other providers in Mt Washington, KY

All providers in Mt Washington, KY · Optometrist in Kentucky

Sources for this page

Verify at the official NPI Registry.