Healthcare Provider Details

I. General information

NPI: 1912286253
Provider Name (Legal Business Name): MEDICAL VISION INSTITUTE, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 HUGUENARD DRIVE SUITE 100
LEXINGTON KY
40503
US

IV. Provider business mailing address

181 PROSPEROUS PL
LEXINGTON KY
40509-1804
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-9486
  • Fax: 888-500-3329
Mailing address:
  • Phone: 859-278-9486
  • Fax: 888-500-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberKY30460
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. JITANDER S DUDEE
Title or Position: PRESIDENT/OPTHALMOLOGIST
Credential: M.D.
Phone: 859-278-9486