Healthcare Provider Details

I. General information

NPI: 1427436682
Provider Name (Legal Business Name): KENTUCKY INSTITUTE FOR EYE HEALTH & SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 E CUMBERLAND AVE
MIDDLESBORO KY
40965-1117
US

IV. Provider business mailing address

601 PERIMETER DR STE 200
LEXINGTON KY
40517-4121
US

V. Phone/Fax

Practice location:
  • Phone: 606-248-7772
  • Fax: 606-248-0575
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: DR. JOHANNES EVANS
Title or Position: OWNER
Credential: MD
Phone: 859-278-9393