Healthcare Provider Details

I. General information

NPI: 1619949971
Provider Name (Legal Business Name): RETINA AND VITREOUS ASSOCIATES OF KENTUCKY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N EAGLE CREEK DR STE 500
LEXINGTON KY
40509-1827
US

IV. Provider business mailing address

120 N EAGLE CREEK DR STE 500
LEXINGTON KY
40509-1827
US

V. Phone/Fax

Practice location:
  • Phone: 859-263-3900
  • Fax: 859-263-3757
Mailing address:
  • Phone: 859-263-3900
  • Fax: 859-263-3757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number1689DT
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH PRAVOOT GIRA
Title or Position: OWNER
Credential: MD
Phone: 314-909-0633