Provider Demographics
NPI:1730907916
Name:BULLOCK, MERRY
Entity type:Individual
Prefix:
First Name:MERRY
Middle Name:
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HANSON
Mailing Address - State:KY
Mailing Address - Zip Code:42413-9499
Mailing Address - Country:US
Mailing Address - Phone:270-875-6420
Mailing Address - Fax:270-322-8192
Practice Address - Street 1:420 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HANSON
Practice Address - State:KY
Practice Address - Zip Code:42413-9499
Practice Address - Country:US
Practice Address - Phone:270-875-6420
Practice Address - Fax:270-322-8192
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician