Basic Information
| Provider Information | |||||||||
| NPI: | 1699824912 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HELDERMAN & JACOBS VISION CENTER, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 N MAYSVILLE ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT STERLING | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403531315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594986001 | ||||||||
| FaxNumber: | 8594970222 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 N MAYSVILLE ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT STERLING | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403531315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594986001 | ||||||||
| FaxNumber: | 8594970222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 01/19/2010 | ||||||||
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| AuthorizedOfficialLastName: | HELDERMAN | ||||||||
| AuthorizedOfficialFirstName: | WAYNE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8594986001 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OPTOMETRIST | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 000000382769 | 01 | KY | BCBS | OTHER | 77000461 | 05 | KY | MEDICAID | 000000382771 | 01 | KY | BCBS | OTHER | 77903722 | 05 | KY | MEDICAID | 77007623 | 05 | KY | MEDICAID |