Healthcare Provider Details

I. General information

NPI: 1184999500
Provider Name (Legal Business Name): DAVID SHANE STRICKLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13324 SHELBYVILLE RD
LOUISVILLE KY
40223-3936
US

IV. Provider business mailing address

13324 SHELBYVILLE RD
LOUISVILLE KY
40223-3936
US

V. Phone/Fax

Practice location:
  • Phone: 502-245-0305
  • Fax:
Mailing address:
  • Phone: 502-245-0305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01073070A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number51779
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: