Organization
SOUTHEASTERN EYE CARE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAROL JO HOLBROOK (OFF MGR)
(606) 672-2040
Entity
Organization
Contact information
Practice address
21937 MAIN ST., HYDEN, KY 41749
(606) 672-2040
(606) 672-3937
Mailing address
21937 MAIN STREET, PO DRW 778, HYDEN, KY 41749-0778
(606) 672-2040
(606) 672-3937
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0902DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77009025
—
KY
Enumeration date
01/17/2007
Last updated
04/02/2008
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