1942309505 NPI number — EYE ASSOCIATES OF DANVILLE PSC

Table of content: (NPI 1942309505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942309505 NPI number — EYE ASSOCIATES OF DANVILLE PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE ASSOCIATES OF DANVILLE 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:
1942309505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
440 WEST MARTIN L KING BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-236-6055
Provider Business Mailing Address Fax Number:
859-236-6117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 WEST MARTIN L KING BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-236-6055
Provider Business Practice Location Address Fax Number:
859-236-6117
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAMSEY
Authorized Official First Name:
BARTON
Authorized Official Middle Name:
LOGAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-236-6055

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)

  • Identifier: 65919797 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: CF7733 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com