Healthcare Provider Details

I. General information

NPI: 1033428768
Provider Name (Legal Business Name): EYE CARE FOR KIDS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3703 TAYLORSVILLE RD SUTIE 120
LOUISVILLE KY
40220-1354
US

IV. Provider business mailing address

3703 TAYLORSVILLE RD SUTIE 120
LOUISVILLE KY
40220-1354
US

V. Phone/Fax

Practice location:
  • Phone: 502-451-5437
  • Fax: 502-451-5141
Mailing address:
  • Phone: 502-451-5437
  • Fax: 502-451-5141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number State

VIII. Authorized Official

Name: PEGGY H FISHMAN
Title or Position: OWNER
Credential:
Phone: 502-451-5437