Basic Information
| Provider Information | |||||||||
| NPI: | 1225103716 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPHTHALMOLOGICAL SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 909 | ||||||||
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| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402010909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025880324 | ||||||||
| FaxNumber: | 5025880326 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 E. MUHAMMAD ALI BLVD | ||||||||
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| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028527665 | ||||||||
| FaxNumber: | 5028528550 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 02/27/2012 | ||||||||
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| AuthorizedOfficialLastName: | KAPLAN | ||||||||
| AuthorizedOfficialFirstName: | HENRY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | DEPARTMENT CHAIR | ||||||||
| AuthorizedOfficialTelephone: | 5028527665 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 225XL0004X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Low Vision | 207W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 65914673 | 05 | KY | MEDICAID | 7100175250 | 05 | KY | MEDICAID | 100003950 | 05 | IN | MEDICAID |