Provider Demographics
NPI:1679534457
Name:TUCKER, JOSEPH CLAY (OD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CLAY
Last Name:TUCKER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 NEW TOWNE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7966
Mailing Address - Country:US
Mailing Address - Phone:270-842-0383
Mailing Address - Fax:270-842-0485
Practice Address - Street 1:335 NEW TOWNE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7966
Practice Address - Country:US
Practice Address - Phone:270-842-0383
Practice Address - Fax:270-842-0485
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0940DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77009405Medicaid
KY1267730001Medicare NSC
KYT54674Medicare UPIN
KY77009405Medicaid
KY9361305Medicare PIN