Organization
CORBIN OPTICAL CO INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY THOMAS TATE OPTICIAN (PRESIDENT CORBIN OPTICAL)
(606) 528-2833
Entity
Organization
Contact information
Practice address
107 KENTUCKY STREET, CORBIN, KY 40701
(606) 528-2833
(606) 528-2862
Mailing address
PO BOX 420, 107 N. KENTUCKY AVE., CORBIN, KY 40702-0420
(606) 528-2833
(606) 528-2862
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
567
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
52905676
—
KY
Enumeration date
01/29/2007
Last updated
06/17/2008
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