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Kenneth D Hasty

Optometrist

Eye and Vision Services Providers

605 N Main St, Shelbyville, TN 37160-3210

(931) 684-2020

PECOS Enrollment

This provider is enrolled in PECOS as KENNETH HASTY.

Based on the most recent information from CMS, provider Kenneth D Hasty is legally eligible to order and refer claims for Part B, HHA and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1164568556
Provider Type
Individual
Full Name
Hasty, Kenneth D
Credential
O.D.

Gender
Male
Sole Proprietor
Yes
Enumeration Date
1/30/2007
Last Updated
4/22/2008

Contact Information

Practice Location

605 N Main St, Shelbyville, TN 37160-3210

(931) 684-2020

(931) 684-7000

Mailing Location

605 N Main St, Shelbyville, TN 37160-3210

(931) 684-2020

(931) 684-7000

Provider Taxonomies

Code	Description	License
Code 152W00000X Primary	Description Optometrist Eye and Vision Services Providers	License 1018 Tennessee
Code 332H00000X	Description Eyewear Supplier Suppliers	License 0752740001 Tennessee

Kenneth D Hasty

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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