Healthcare Provider Details

I. General information

NPI: 1932841160
Provider Name (Legal Business Name): JEFFREY CRAIG POWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
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

PO BOX 736509
CHICAGO IL
60673-1408
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number61837
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: