Provider Demographics
NPI:1053369892
Name:HARDINSBURG EYECARE CENTER PLLC
Entity type:Organization
Organization Name:HARDINSBURG EYECARE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VAUGHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-756-6202
Mailing Address - Street 1:500 BALLPARK RD
Mailing Address - Street 2:
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-5801
Mailing Address - Country:US
Mailing Address - Phone:270-756-6202
Mailing Address - Fax:270-756-1906
Practice Address - Street 1:500 BALLPARK RD
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-5801
Practice Address - Country:US
Practice Address - Phone:270-756-6202
Practice Address - Fax:270-756-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY763DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77904076Medicaid
KY77904076Medicaid
KY5621380001Medicare NSC