Provider Demographics
NPI:1548666076
Name:HARGUS, SAMUEL R II (OD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:R
Last Name:HARGUS
Suffix:II
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1483 S DIXIE ST
Mailing Address - Street 2:
Mailing Address - City:HORSE CAVE
Mailing Address - State:KY
Mailing Address - Zip Code:42749-1457
Mailing Address - Country:US
Mailing Address - Phone:270-786-2085
Mailing Address - Fax:270-786-1215
Practice Address - Street 1:1483 S DIXIE ST
Practice Address - Street 2:
Practice Address - City:HORSE CAVE
Practice Address - State:KY
Practice Address - Zip Code:42749-1457
Practice Address - Country:US
Practice Address - Phone:270-786-2085
Practice Address - Fax:270-786-1215
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN18003877A152W00000X
KY1972DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1548666076Medicare NSC