Basic Information
| Provider Information | |||||||||
| NPI: | 1598855587 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EYE SPECIALISTS OF LOUISVILLE, PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 E MUHAMMAD ALI BLVD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028525466 | ||||||||
| FaxNumber: | 5028528550 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 E MUHAMMAD ALI BLVD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028525466 | ||||||||
| FaxNumber: | 5028528550 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 01/24/2011 | ||||||||
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| AuthorizedOfficialLastName: | SCHULMAN | ||||||||
| AuthorizedOfficialFirstName: | HARRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5028525455 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | EYE SPECIALISTS OF LOUISVILLE, PSC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.