Organization
MOUNTAIN OPTICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE SUE KECK OPTICIAN (OWNER)
(606) 248-6030
Entity
Organization
Contact information
Practice address
2145 US HIGHWAY 25 E, MIDDLESBORO, KY 40965-1874
(606) 248-6030
(606) 248-0014
Mailing address
2145 US HIGHWAY 25 E, MIDDLESBORO, KY 40965-1874
(606) 248-6030
(606) 248-0014
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
—
—
332H00000X
Eyewear Supplier
Primary
0478
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000072724
BCBS
KY
05
—
52904786
—
KY
01
—
KY0478
EYEMED
KY
Enumeration date
10/16/2007
Last updated
09/02/2015
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