Basic Information
| Provider Information | |||||||||
| NPI: | 1518572957 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KENTUCKY INSTITUTE FOR EYE HEALTH & SURGERY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | KENTUCKY EYE INSTITUTE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 PERIMETER DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405174121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592789393 | ||||||||
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| Practice Location | |||||||||
| Address1: | 149 FRANKFORT ST | ||||||||
| Address2: | |||||||||
| City: | VERSAILLES | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403831121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8598737805 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2020 | ||||||||
| LastUpdateDate: | 05/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | DOOLIN | ||||||||
| AuthorizedOfficialFirstName: | SHERRI | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER/AM | ||||||||
| AuthorizedOfficialTelephone: | 8592789393 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | KENTUCKY INSTITUTE FOR EYE HEALTH & SURGERY | ||||||||
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| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.