Basic Information
| Provider Information | |||||||||
| NPI: | 1336503820 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAMPAT | ||||||||
| FirstName: | MANAN | ||||||||
| MiddleName: | RAJU | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 990 | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404230990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592392318 | ||||||||
| FaxNumber: | 8599364520 | ||||||||
| Practice Location | |||||||||
| Address1: | 1541 LEBANON RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404228349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592394500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2016 | ||||||||
| LastUpdateDate: | 07/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 53516 | KY | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.