Healthcare Provider Details

I. General information

NPI: 1497498398
Provider Name (Legal Business Name): FLYING EYE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 ESTILL ST FL 4
BEREA KY
40403-1742
US

IV. Provider business mailing address

1401 HARRODSBURG RD STE B290
LEXINGTON KY
40504-1730
US

V. Phone/Fax

Practice location:
  • Phone: 606-666-9393
  • Fax: 606-666-4131
Mailing address:
  • Phone: 859-277-2692
  • Fax: 859-277-9275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHERRI DOOLIN
Title or Position: BILLING/CREDENTIALING MANAGER
Credential:
Phone: 859-338-8590