Healthcare Provider Details

I. General information

NPI: 1790486017
Provider Name (Legal Business Name): MELINDA JILL HOTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3795 E JOHN ROWAN BLVD
BARDSTOWN KY
40004-3214
US

IV. Provider business mailing address

3795 E JOHN ROWAN BLVD
BARDSTOWN KY
40004-3214
US

V. Phone/Fax

Practice location:
  • Phone: 502-350-4797
  • Fax: 502-350-4794
Mailing address:
  • Phone: 502-350-4797
  • Fax: 502-350-4794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: