Individual
DR. GARY WALTER UPCHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
127 FOOTHILLS AVE STE 3, ALBANY, KY 42602-1037
(606) 387-5612
(606) 387-6602
Mailing address
PO BOX 306, FERGUSON, KY 42533-0306
(606) 492-2211
(606) 676-0873
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
929DT
KY
152W00000X
Optometrist
OD2197
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01047034
AMERIGROUP
—
01
—
3068022
BCBSTN/BLUECARE/TENNCARE
—
01
—
410003588
RAILROAD MEDICARE
KY
05
—
4599126
—
TN
01
—
4627
AVESIS/MEDICAID
KY
05
—
7100209970
—
KY
05
—
77009298
—
KY
Enumeration date
08/10/2005
Last updated
12/03/2019
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