Healthcare Provider Details

I. General information

NPI: 1669529715
Provider Name (Legal Business Name): KENTUCKY INSTITUTE FOR EYE HEALTH AND SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1937 OLD MAIN ST STE 1
MAYSVILLE KY
41056-8956
US

IV. Provider business mailing address

601 PERIMETER DR STE 100
LEXINGTON KY
40517-4121
US

V. Phone/Fax

Practice location:
  • Phone: 606-759-7883
  • Fax: 606-759-0683
Mailing address:
  • Phone: 859-278-9393
  • Fax: 859-278-0923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: AMBER WILSON WITT
Title or Position: BILLING MANAGER
Credential:
Phone: 859-278-9393