Healthcare Provider Details

I. General information

NPI: 1700132339
Provider Name (Legal Business Name): AYALA M LANNON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AYALA SOLIS

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6812 DIXIE HWY
LOUISVILLE KY
40258-3914
US

IV. Provider business mailing address

4000 POPLAR LEVEL RD
LOUISVILLE KY
40213-1524
US

V. Phone/Fax

Practice location:
  • Phone: 502-933-7986
  • Fax: 502-933-2652
Mailing address:
  • Phone: 502-459-2020
  • Fax: 502-456-9121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00641400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: