Organization
MAR-TAN FAMILY VISION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIMMIE T PHELPS (OWNER / OPTICIAN)
(859) 623-4267
Entity
Organization
Contact information
Practice address
205 GERI LN, RICHMOND, KY 40475-2359
(859) 623-4267
(859) 623-4249
Mailing address
205 GERI LN, RICHMOND, KY 40475-2359
(859) 623-4267
(859) 623-4249
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
KY325
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000195501
ANTHEM
KY
01
—
1141
PVC
KY
01
—
1188575
CHA
KY
01
—
2537729
CIGNA
KY
01
—
260155886
TRICARE
KY
01
—
32646
CVC
KY
05
—
52800919
—
KY
05
—
52903259
—
KY
01
—
OP0933
EYEMED
KY
Enumeration date
08/09/2005
Last updated
12/22/2009
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