Healthcare Provider Details

I. General information

NPI: 1437151099
Provider Name (Legal Business Name): LLOYD ROSS TAUSTINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1169 EASTERN PKWY STE 1211
LOUISVILLE KY
40217-1462
US

IV. Provider business mailing address

6400 DUTCHMANS PKWY STE 125
LOUISVILLE KY
40205-3342
US

V. Phone/Fax

Practice location:
  • Phone: 502-896-8700
  • Fax: 502-896-0813
Mailing address:
  • Phone: 502-896-8700
  • Fax: 502-896-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number19646
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number28394
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: