Healthcare Provider Details

I. General information

NPI: 1013015510
Provider Name (Legal Business Name): KENTUCKY INSTITUTE FOR EYE HEALTH & SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
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 SUITE 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 TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number31282
License Number StateKY

VIII. Authorized Official

Name: MR. ARIC MYERS
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 859-278-9393