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General NPI Number Information
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NPI Number | 1194834713
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL OPTICIANS PSC
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 165 MOORE DR
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City | LEXINGTON
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State | KY
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Zip | 40503
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Country | US
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Telephone | 859-278-5409
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Fax | 859-276-3491
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Provider Business Mailing Address
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Address Line | 165 MOORE DR
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City | LEXINGTON
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State | KY
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Zip | 40503
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Country | US
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Telephone | 859-278-5409
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Fax | 859-276-3491
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN C HOLTMANN
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Credential | ABO
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Telephone | 859-278-5409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 0366
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License Number State | KY
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