Healthcare Provider Details

I. General information

NPI: 1952838716
Provider Name (Legal Business Name): KENTUCKY EYE CARE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 ADAM SHEPHERD PKWY STE 20
SHEPHERDSVILLE KY
40165-6579
US

IV. Provider business mailing address

6400 DUTCHMANS PKWY STE 125
LOUISVILLE KY
40205-3340
US

V. Phone/Fax

Practice location:
  • Phone: 502-215-7094
  • Fax: 502-896-0813
Mailing address:
  • Phone: 502-896-8700
  • Fax: 502-896-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARK AARON IHNEN
Title or Position: PHYSICIAN
Credential: MD
Phone: 502-896-5750