Individual
LARRY TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LDO
Contact information
Practice address
107 KENTUCKY STREET, CORBIN, KY 40701
(606) 528-2833
(606) 528-2862
Mailing address
PO BOX 420, CORBIN, KY 40702-0420
(606) 528-2833
(606) 528-2862
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
0567
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
52905676
—
KY
Enumeration date
05/02/2014
Last updated
05/02/2014
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