Basic Information
| Provider Information | |||||||||
| NPI: | 1265165427 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JASINSKI | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | APPRENTICE OPTICIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6501 VETERANS MEMORIAL PKWY | ||||||||
| Address2: | |||||||||
| City: | CRESTWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400148694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022439767 | ||||||||
| FaxNumber: | 5022439768 | ||||||||
| Practice Location | |||||||||
| Address1: | 6501 VETERANS MEMORIAL PKWY | ||||||||
| Address2: | |||||||||
| City: | CRESTWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400148694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022439767 | ||||||||
| FaxNumber: | 5022439768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2022 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | 274158 | KY | Y | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.