Healthcare Provider Details

I. General information

NPI: 1477006971
Provider Name (Legal Business Name): ROMINA A. HOUSTON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5023 MUD LN STE 110
LOUISVILLE KY
40229-2800
US

IV. Provider business mailing address

5023 MUD LN STE 110
LOUISVILLE KY
40229-2800
US

V. Phone/Fax

Practice location:
  • Phone: 502-964-9400
  • Fax: 502-964-1915
Mailing address:
  • Phone: 502-964-9400
  • Fax: 502-964-1915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2038DT
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003995A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: