Healthcare Provider Details

I. General information

NPI: 1003098765
Provider Name (Legal Business Name): MELISSA BALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 N MCWHORTER ST SUITE 1
LONDON KY
40741-2235
US

IV. Provider business mailing address

356 N MCWHORTER ST SUITE 1
LONDON KY
40741-2235
US

V. Phone/Fax

Practice location:
  • Phone: 606-877-6585
  • Fax: 606-877-9936
Mailing address:
  • Phone: 606-877-6585
  • Fax: 606-877-9936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1337DT
License Number StateKY

VIII. Authorized Official

Name: DR. MELISSA BALL
Title or Position: OWNER/OPTOMETRIST
Credential: O.D.
Phone: 606-877-6585