Healthcare Provider Details

I. General information

NPI: 1871626861
Provider Name (Legal Business Name): RICHARD W. LAZICH, AU.D. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4135 SHELBYVILLE RD
LOUISVILLE KY
40207-3203
US

IV. Provider business mailing address

4135 SHELBYVILLE RD
LOUISVILLE KY
40207-3203
US

V. Phone/Fax

Practice location:
  • Phone: 502-890-3921
  • Fax: 502-890-3923
Mailing address:
  • Phone: 502-890-3921
  • Fax: 502-890-3923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberKY-0066
License Number StateKY

VIII. Authorized Official

Name: DR. RICHARD LAZICH
Title or Position: OWNER
Credential:
Phone: 502-345-8375