Healthcare Provider Details

I. General information

NPI: 1144344110
Provider Name (Legal Business Name): CYNTHIA ELAM CORBIN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N ALLISON AVE
BARBOURVILLE KY
40906-1335
US

IV. Provider business mailing address

25 HAPPY DAY RD
BARBOURVILLE KY
40906-7255
US

V. Phone/Fax

Practice location:
  • Phone: 606-546-2200
  • Fax: 606-546-2709
Mailing address:
  • Phone: 606-546-3160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1509DT
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1509DT
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1509DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: