Provider Demographics
NPI:1043459597
Name:EYEMART FAMILY VISION CARE INC
Entity type:Organization
Organization Name:EYEMART FAMILY VISION CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-499-2020
Mailing Address - Street 1:9501 TAYLORSVILLE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2752
Mailing Address - Country:US
Mailing Address - Phone:606-666-4585
Mailing Address - Fax:606-666-4583
Practice Address - Street 1:100 HIGHWAY 15 S
Practice Address - Street 2:SUITE 108
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-8636
Practice Address - Country:US
Practice Address - Phone:606-666-4585
Practice Address - Fax:606-666-4583
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE MART FAMILY VISION CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-06
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100074570Medicaid
KY0822860002Medicare NSC