1104587591 NPI number — CENTRAL KENTUCKY EYECARE AND WELLNESS, LLC

Table of content: TERRY LYNN BOYLE D.P.M. (NPI 1861442675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104587591 NPI number — CENTRAL KENTUCKY EYECARE AND WELLNESS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL KENTUCKY EYECARE AND WELLNESS, LLC
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:
Provider Other Organization Name Type Code:
6
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:
1104587591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3221 SUMMIT SQUARE PL STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40509-2655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-303-6464
Provider Business Mailing Address Fax Number:
859-303-6465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3221 SUMMIT SQUARE PL STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40509-2655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-303-6464
Provider Business Practice Location Address Fax Number:
859-303-6465
Provider Enumeration Date:
01/06/2022

Additional Information

Authorized Official

Authorized Official Last Name:
HUGHES
Authorized Official First Name:
VELVA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
859-447-0895

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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