Organization Name: | KENTUCKY OPTICAL EXPRESS, INC. |
NPI Number: | 1679745756 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WALLACE BULLARD GUERRANT (PRESIDENT AND CEO) |
Mailing Address: | 122 Stone Trace Drive Suite B Mount Sterling |
State: | KY US |
Postal Code: | 40353 |
Phone Number: | 8884972117 |
Fax Number: | 8594972542 |
NPI Enumeration Date: | 03/28/2008 |
NPI Last Update Date: | 03/19/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |