1902843378 NPI number — CENTRAL KENTUCKY OPTOMETRIC ASSOCIATES PSC

Table of content: MRS. KRISTINE K CLAAR OTR L, CHT, CLT (NPI 1225042534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902843378 NPI number — CENTRAL KENTUCKY OPTOMETRIC ASSOCIATES PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL KENTUCKY OPTOMETRIC ASSOCIATES 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:
Provider Other Organization Name Type Code:
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:
1902843378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 W HIGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40033-1428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-692-1871
Provider Business Mailing Address Fax Number:
270-692-6785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 W HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40033-1428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-692-1871
Provider Business Practice Location Address Fax Number:
270-692-6785
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLINGSWORTH-CECCONI
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SECTREAS
Authorized Official Telephone Number:
270-692-1871

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , 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: 1902843378 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 77903391 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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