Healthcare Provider Details

I. General information

NPI: 1386558328
Provider Name (Legal Business Name): LEGACY EYE CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10903 MEETING ST
PROSPECT KY
40059-5504
US

IV. Provider business mailing address

10903 MEETING ST
PROSPECT KY
40059-5504
US

V. Phone/Fax

Practice location:
  • Phone: 513-827-0874
  • Fax:
Mailing address:
  • Phone: 513-827-0874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAWRENCE TENKMAN
Title or Position: OWNER
Credential:
Phone: 513-827-0874