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205 W 15th St, Hopkinsville, KY 42240-2035 | |
(270) 886-2020 | |
(270) 885-6271 |
Full Name | |
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Type | Facility |
Speciality | Ophthalmology |
Location | 205 W 15th St, Hopkinsville, Kentucky |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1578675518 | NPI | - | NPPES |
65927758 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 1852DT (Kentucky) | Secondary |
207W00000X | Ophthalmology | 33605 (Kentucky) | Primary |
Provider Name | Paul K Herrell |
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Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1336134998 PECOS PAC ID: 9537204714 Enrollment ID: I20100720000041 |
Provider Name | Amber C Lane |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1144518010 PECOS PAC ID: 1658541263 Enrollment ID: I20110908001930 |
Mailing Address | Practice Location Address |
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205 W 15th St, Hopkinsville, KY 42240-2035 Ph: (270) 886-2020 | 205 W 15th St, Hopkinsville, KY 42240-2035 Ph: (270) 886-2020 |