Healthcare Provider Details

I. General information

NPI: 1164611547
Provider Name (Legal Business Name): SOUTH HILL EYE CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 S UPPER ST SUITE 195
LEXINGTON KY
40508-2935
US

IV. Provider business mailing address

535 SOUTH UPPER STREET SUITE 195
LEXINGTON KY
40508
US

V. Phone/Fax

Practice location:
  • Phone: 859-259-3768
  • Fax: 859-281-9582
Mailing address:
  • Phone: 859-259-3768
  • Fax: 859-281-9582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number15652DT
License Number StateKY

VIII. Authorized Official

Name: STEVEN N SPEAR
Title or Position: OPTOMETRIST
Credential: O. D.
Phone: 859-259-3768