Basic Information
| Provider Information | |||||||||
| NPI: | 1073781324 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYE CONSULTANTS OF KENTUCKY PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 N EAGLE CREEK DR STE 211 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405091827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592633030 | ||||||||
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| Practice Location | |||||||||
| Address1: | 120 N EAGLE CREEK DR STE 211 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405091827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592633030 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2008 | ||||||||
| LastUpdateDate: | 02/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | OFFUTT | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5028633436 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 15131 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 0060 | 01 | KY | MEDICARE GROUP NUMBER | OTHER |