Healthcare Provider Details

I. General information

NPI: 1861687048
Provider Name (Legal Business Name): NEW LEXINGTON CLINIC, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 S BROADWAY ST
GEORGETOWN KY
40324-1463
US

IV. Provider business mailing address

PO BOX 11790
LEXINGTON KY
40578-1790
US

V. Phone/Fax

Practice location:
  • Phone: 502-868-0422
  • Fax: 502-867-1967
Mailing address:
  • Phone: 859-258-6000
  • Fax: 859-258-6123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: RANDALL LEMAY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 859-258-4101