Healthcare Provider Details

I. General information

NPI: 1285597807
Provider Name (Legal Business Name): KY DOCTORS OF OPTOMETRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CHERRY BLOSSOM WAY
GEORGETOWN KY
40324-9564
US

IV. Provider business mailing address

19100 RIDGEWOOD PKWY
SAN ANTONIO TX
78259-1834
US

V. Phone/Fax

Practice location:
  • Phone: 726-444-4078
  • Fax:
Mailing address:
  • Phone: 726-444-4078
  • Fax: 210-524-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: GRANT RUBESH
Title or Position: OWNER
Credential:
Phone: 502-449-2080