Healthcare Provider Details

I. General information

NPI: 1619033131
Provider Name (Legal Business Name): KENTUCKY INSTITUTE FOR EYE HEALTH AND SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 EAST CITY DAM RD
CORBIN KY
40701-4620
US

IV. Provider business mailing address

1401 HARRODSBURG RD STE B75
LEXINGTON KY
40504-1724
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-9393
  • Fax: 606-528-9397
Mailing address:
  • Phone: 859-278-9393
  • Fax: 859-278-0923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH E WOODWORTH JR.
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 859-278-9393