1720190101 NPI number — ASSOCIATES IN EYE CARE, INC.

Table of content: (NPI 1720190101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720190101 NPI number — ASSOCIATES IN EYE CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATES IN EYE CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720190101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 306
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FERGUSON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42533-0306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-492-2211
Provider Business Mailing Address Fax Number:
606-676-0873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 FOOTHILLS AVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42602-1090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-387-5612
Provider Business Practice Location Address Fax Number:
606-387-6602
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
UPCHURCH
Authorized Official First Name:
GARY
Authorized Official Middle Name:
WALTER
Authorized Official Title or Position:
PRESIDENT AND AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
606-387-5612

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0096603 . This is a "MEDICARE # FOR DR. MARK JACOBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 39973; 4209301 . This is a "BCBSTN/BLUECARE/TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7100184290 . This is a "MEDICAID # FOR DR. BENJAMIN BRENNER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 77012011 . This is a "MEDICAID # FOR DR. MARK JACOBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 46411 . This is a "OPTUMHEALTH VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 77900520 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: CP0230:013 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: K009923 . This is a "MEDICARE PTAN # FOR DR. BRENNER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 77009298 . This is a "MEDICAID # FOR DR. GARY UPCHURCH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: CB8623 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0096602 . This is a "MEDICARE # FOR DR. GARY UPCHURCH" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1511738 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100209970 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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