Individual
CHASEY MADISON TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
104 SMOKY WAY STE 100, DANVILLE, KY 40422-8729
(859) 236-8644
Mailing address
670 FALLS LN, GRAYSON, KY 41143-7555
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2212DT
KY
Other
Enumeration date
12/02/2020
Last updated
12/02/2020
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