Healthcare Provider Details

I. General information

NPI: 1205233616
Provider Name (Legal Business Name): UK OPTICAL SHOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE
LEXINGTON KY
40536-0284
US

IV. Provider business mailing address

2333 ALUMNI PARK PLAZA SUITE 200
LEXINGTON KY
40517-4022
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-3105
  • Fax:
Mailing address:
  • Phone: 859-257-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CRAIG COLLINS
Title or Position: SR VP HEALTH AFFAIRS / CFO
Credential:
Phone: 859-257-1773