Organization
SOUTHERN KENTUCKY EYE CENTER PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRI COOMER (BILLING DEPT MANAGER)
(606) 679-5837
Entity
Organization
Contact information
Practice address
120 TRADEPARK DR, SUITE A, SOMERSET, KY 42503-3454
(606) 679-7778
(606) 451-1814
Mailing address
120 TRADEPARK DR, SUITE A, SOMERSET, KY 42503-3454
(606) 679-7778
(606) 451-1814
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000041743
BLUECROSS BLUE SHIELD
KY
01
—
1520956
UMWA
KY
01
—
180028760
RAILROAD MEDICARE
—
01
—
3061400
BCBS
TN
05
—
4020794
—
TN
05
—
65928939
—
KY
Enumeration date
02/13/2007
Last updated
07/16/2019
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