1336230077 NPI number — ASSOCIATES IN EYE CARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336230077 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:
1336230077
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:
2523 JACKSBORO PK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37757-4847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-566-2020
Provider Business Practice Location Address Fax Number:
423-566-4245
Provider Enumeration Date:
09/27/2006

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 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 174791 . This is a "BCBSTN/BLUECARE/TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3942271 . This is a "MEDICAID # FOR DR. SANDY MYSLIWIEC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3941347 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3941367; 3941363 . This is a "MEDICARE PIN FOR DR. KEVIN MYSLIWIEC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: CO0230:012 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3941367; 3941363 . This is a "MEDICAID # FOR DR. KEVIN MYSLIWIEC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 62081 . This is a "OPTUMHEALTH VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: CJ5379 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3942271 . This is a "MEDICARE PIN FOR DR. SANDY MYSLIWIEC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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