MEDICARE: RON HADDAD OD

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	152W00000X	Optometrist	2354DT	KY

General Provider Information

NPI Number	:	1952083958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RON HADDAD OD

Provider Business Mailing Address
First Line	:	114 E REYNOLDS RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-1248
Country	:	US
Telephone Number	:	832-722-0193
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 E REYNOLDS RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-1248
Country	:	US
Telephone Number	:	859-216-2660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	10/24/2024

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Directions to “ RON HADDAD OD” Practice Location

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