Provider Demographics
NPI:1730210287
Name:MARY ANNE BELCHER OD PSC
Entity type:Organization
Organization Name:MARY ANNE BELCHER OD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BELCHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-754-5775
Mailing Address - Street 1:PO BOX 1237
Mailing Address - Street 2:
Mailing Address - City:ELKHORN CITY
Mailing Address - State:KY
Mailing Address - Zip Code:41522-1237
Mailing Address - Country:US
Mailing Address - Phone:606-754-5775
Mailing Address - Fax:606-754-5775
Practice Address - Street 1:20 SPRING AVE
Practice Address - Street 2:
Practice Address - City:ELKHORN CITY
Practice Address - State:KY
Practice Address - Zip Code:41522
Practice Address - Country:US
Practice Address - Phone:606-754-5775
Practice Address - Fax:606-754-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1059DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY410046162OtherPALMETTO/ RR MEDICARE
KY77903433Medicaid
KY410046162OtherPALMETTO/ RR MEDICARE
KYT54716Medicare UPIN
KY77903433Medicaid