Healthcare Provider Details

I. General information

NPI: 1245204304
Provider Name (Legal Business Name): LAUREL MORRIS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREL VAN HORN O.D.

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W 5TH ST
BENTON KY
42025-1123
US

IV. Provider business mailing address

PO BOX 256
BENTON KY
42025-0256
US

V. Phone/Fax

Practice location:
  • Phone: 270-527-7421
  • Fax: 270-527-3118
Mailing address:
  • Phone: 270-527-7421
  • Fax: 270-527-3118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1469DT
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1469DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: