1730598426 NPI number — KENTUCKY INSTITUTE FOR EYE HEALTH & SURGERY

Table of content: (NPI 1730598426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730598426 NPI number — KENTUCKY INSTITUTE FOR EYE HEALTH & SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENTUCKY INSTITUTE FOR EYE HEALTH & 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:
1730598426
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
Provider Second Line Business Mailing Address:
B75
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:
333 BEACON HILL RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MOREHEAD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40351-6178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-784-3393
Provider Business Practice Location Address Fax Number:
606-794-3763
Provider Enumeration Date:
08/06/2014

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
JOHANNES
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER/MD
Authorized Official Telephone Number:
859-278-9393

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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