Organization
BEREA OPTICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBA JUNE FRANK (OWNER)
(859) 985-0044
Entity
Organization
Contact information
Practice address
400 RICHMOND RD N, STE. F, BEREA, KY 40403-1015
(859) 985-0044
(859) 985-0045
Mailing address
400 RICHMOND RD N, SUITE F, BEREA, KY 40403-1015
(859) 985-0044
(859) 985-0045
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
KY 1075
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
52000130
—
KY
01
—
KY 1075
EYEMED
KY
Enumeration date
04/16/2007
Last updated
08/22/2020
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