Healthcare Provider Details

I. General information

NPI: 1447898127
Provider Name (Legal Business Name): DONALD KEITH NEWLAND LDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 02/01/2020
Certification Date: 02/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8107 LA GRANGE RD
LOUISVILLE KY
40222-3817
US

IV. Provider business mailing address

8107 LA GRANGE RD
LOUISVILLE KY
40222-3817
US

V. Phone/Fax

Practice location:
  • Phone: 502-905-4113
  • Fax:
Mailing address:
  • Phone: 502-905-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number111736
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: