Healthcare Provider Details

I. General information

NPI: 1609930791
Provider Name (Legal Business Name): CASAK WOODHILL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 E NEW CIRCLE RD SUITE #146
LEXINGTON KY
40509-1043
US

IV. Provider business mailing address

1555 E NEW CIRCLE RD SUITE #146
LEXINGTON KY
40509-1043
US

V. Phone/Fax

Practice location:
  • Phone: 859-266-3003
  • Fax: 859-266-9504
Mailing address:
  • Phone: 859-266-3003
  • Fax: 859-266-9504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number244184
License Number StateKY

VIII. Authorized Official

Name: STEVEN AMBROSE KLECKER
Title or Position: MANAGING MEMBER
Credential: OD
Phone: 859-266-3003