Organization
BREIWA, WARE & JESKIE PSC
Active
Other names
Vision Source of Scottsville
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN W JESKIE OD (VICE PRESIDENT)
(270) 237-5434
Entity
Organization
Contact information
Practice address
390 OLD GALLATIN RD, SCOTTSVILLE, KY 42164-8954
(270) 237-5434
(270) 237-3529
Mailing address
P.O. BOX 480, 390 OLD GALLATIN RD, SCOTTSVILLE, KY 42164-8954
(270) 237-5434
(270) 237-3529
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06623
SPECTERA
KY
01
—
5368825900118
NATIONAL VISION ADMINIST
KY
05
—
77903219
—
KY
Enumeration date
04/11/2007
Last updated
10/31/2014
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