MEDICARE: OPHTHALMOLOGY ASSOCIATES, PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist
2	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871568527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPHTHALMOLOGY ASSOCIATES, PSC

Provider Business Mailing Address
First Line	:	3810 SPRINGHURST BLVD STE 100
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-6162
Country	:	US
Telephone Number	:	502-897-9881
Fax Number	:	502-897-9824

Provider Business Practice Location Address
First Line	:	3810 SPRINGHURST BLVD STE 100
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-6162
Country	:	US
Telephone Number	:	502-897-9881
Fax Number	:	502-897-9824

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	DIANA HOPUY I
Credential	:
Telephone Number	:	502-897-9881

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	10/22/2020

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