Basic Information
| Provider Information | |||||||||
| NPI: | 1568537959 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY EYE CLINIC AND EDUCATIONAL FOUNDATION, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 E. MUHAMMAD ALI BLVD. | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE, | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028527665 | ||||||||
| FaxNumber: | 5028524947 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 E. MUHAMMAD ALI BLVD. | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028527665 | ||||||||
| FaxNumber: | 5028524947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SOLTAU | ||||||||
| AuthorizedOfficialFirstName: | JOERN | ||||||||
| AuthorizedOfficialMiddleName: | B. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5028527665 | ||||||||
| IsSoleProprietor: | |||||||||
| 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 | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 65908931 | 05 | KY | MEDICAID |