Provider Demographics
NPI:1184771545
Name:BUCKNER, JAMES FRED JR (DOCTOR OF OPTOMETRY)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FRED
Last Name:BUCKNER
Suffix:JR
Gender:M
Credentials:DOCTOR OF OPTOMETRY
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2804
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:KY
Mailing Address - Zip Code:42135-2804
Mailing Address - Country:US
Mailing Address - Phone:270-586-3937
Mailing Address - Fax:270-586-7671
Practice Address - Street 1:1300 BLUEGRASS RD
Practice Address - Street 2:SUITE A
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134-1981
Practice Address - Country:US
Practice Address - Phone:270-586-3937
Practice Address - Fax:270-586-7371
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY1148 DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77011484Medicaid
KY000000049744OtherBCBS
KY0967950001Medicare NSC
T 19564Medicare UPIN
9307801Medicare ID - Type Unspecified