Healthcare Provider Details

I. General information

NPI: 1144411141
Provider Name (Legal Business Name): DR. CYNTHIA CORBIN O.D. PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
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

112 N ALLISON AVE
BARBOURVILLE KY
40906-1335
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1509DT
License Number StateKY

VIII. Authorized Official

Name: DR. CYNTHIA ELAM CORBIN
Title or Position: OPTOMETRIST/OWNER
Credential: O.D.
Phone: 606-546-2200