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General NPI Number Information
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NPI Number | 1316329709
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Entity Type | Organization
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Legal Business Name | EAGLE VIEW PLASTIC SURGERY
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Dates
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Enumeration Date | 06/23/2015
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Last Update Date | 06/23/2015
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Provider Practice Location Address
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Address Line | 3288 EAGLE VIEW LN SUITE 300
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City | LEXINGTON
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State | KY
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Zip | 40509-9020
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Country | US
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Telephone | 859-254-5665
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Fax | 859-281-6825
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Provider Business Mailing Address
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Address Line | 3288 EAGLE VIEW LN SUITE 300
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City | LEXINGTON
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State | KY
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Zip | 40509-9020
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Country | US
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Telephone | 859-254-5665
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Fax | 859-281-6825
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Authorized Official
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Title or Position | OWNER
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Name | S. RANDOLPH WALDMAN
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Credential | MD
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Telephone | 859-254-5665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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