Organization
FAMILY EYEHEALTH CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG S PENNELL OD (OWNER)
(859) 363-3347
Entity
Organization
Contact information
Practice address
1824 DECLARATION DR, INDEPENDENCE, KY 41051-8196
(859) 363-3347
Mailing address
1824 DECLARATION DR, INDEPENDENCE, KY 41051-8196
(859) 363-3347
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1168DT
KY
332H00000X
Eyewear Supplier
1168DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77903938
—
KY
Enumeration date
03/19/2007
Last updated
09/18/2013
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