1619033131 NPI number — KENTUCKY INSTITUTE FOR EYE HEALTH AND SURGERY

Table of content: DR. DANIEL RAYMOND GRAY DOM (NPI 1013356658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619033131 NPI number — KENTUCKY INSTITUTE FOR EYE HEALTH AND SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENTUCKY INSTITUTE FOR EYE HEALTH AND SURGERY
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:
1619033131
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 HARRODSBURG RD STE B75
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:
40504-1724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-278-9393
Provider Business Mailing Address Fax Number:
859-278-0923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 EAST CITY DAM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701-4620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-528-9393
Provider Business Practice Location Address Fax Number:
606-528-9397
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WOODWORTH
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CHIEF OPERATIONS OFFICER
Authorized Official Telephone Number:
859-278-9393

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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