Healthcare Provider Details

I. General information

NPI: 1477637726
Provider Name (Legal Business Name): KY DOCTORS OF OPTOMETRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 HINKLEVILLE ROAD
PADUCAH KY
42001
US

IV. Provider business mailing address

PO BOX 846027
DALLAS TX
75284-6027
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-2090
  • Fax: 270-444-2086
Mailing address:
  • Phone: 210-524-6663
  • Fax: 210-524-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: GRANT RUBESH
Title or Position: OWNER
Credential: O.D.
Phone: 726-444-4078