Healthcare Provider Details

I. General information

NPI: 1629652938
Provider Name (Legal Business Name): KENTUCKY INSTITUTE FOR EYE HEALTH & SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 SHAKER DR STE 110
LEXINGTON KY
40504-3674
US

IV. Provider business mailing address

601 PERIMETER DR STE 200
LEXINGTON KY
40517-4121
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-9393
  • Fax: 859-278-0923
Mailing address:
  • Phone: 859-278-9393
  • Fax: 859-278-0923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHERRI ANN DOOLIN
Title or Position: BILLING/CREDENTIALING MANAGER
Credential:
Phone: 859-278-9393