Healthcare Provider Details

I. General information

NPI: 1285215103
Provider Name (Legal Business Name): PDS CONSULTANTS OPTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 04/21/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4036 DUTCHMANS LN
LOUISVILLE KY
40207-4704
US

IV. Provider business mailing address

4036 DUTCHMANS LN
LOUISVILLE KY
40207-4704
US

V. Phone/Fax

Practice location:
  • Phone: 502-895-2020
  • Fax: 502-657-4982
Mailing address:
  • Phone: 502-895-2020
  • Fax: 502-657-4982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN BAKER
Title or Position: COO
Credential:
Phone: 502-895-2020