1801118492 NPI number — BRIAN KEPLINGER, O.D., PSC

Table of content: (NPI 1801118492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801118492 NPI number — BRIAN KEPLINGER, O.D., PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIAN KEPLINGER, O.D., PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PREMIER FAMILY EYECARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801118492
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 GRANDVIEW DR
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
FRANKFORT
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40601-3235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-695-1771
Provider Business Mailing Address Fax Number:
502-695-1448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 GRANDVIEW DR
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40601-3235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-695-1771
Provider Business Practice Location Address Fax Number:
502-695-1448
Provider Enumeration Date:
02/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KEPLINGER
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
LEIGH
Authorized Official Title or Position:
PRESIDENT/ OPTOMETRIST
Authorized Official Telephone Number:
502-695-1771

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1484-DT , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000287821 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7404229 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 77000339 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2200221 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 383697423 . This is a "BLUEGRASS FAMILY HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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