Basic Information
| Provider Information | |||||||||
| NPI: | 1053054940 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FLYING EYE PLLC | ||||||||
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| OtherOrganizationName: | KENTUCKY EYE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 HARRODSBURG RD STE B290 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405041730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592772692 | ||||||||
| FaxNumber: | 8592779275 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 HIGHWAY 15 S STE 108 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 413398895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066669393 | ||||||||
| FaxNumber: | 6066664131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2022 | ||||||||
| LastUpdateDate: | 04/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | DOOLIN | ||||||||
| AuthorizedOfficialFirstName: | SHERRI | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING/CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8593388590 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 332H00000X | N | Suppliers | Eyewear Supplier (Equipment, not the service) | 207W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.