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General NPI Number Information
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NPI Number | 1396152617
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Entity Type | Organization
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Legal Business Name | KENTUCKY INSTITUTE FOR EYE HEALTH AND SURGERY
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Dates
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Enumeration Date | 07/18/2014
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 103 BRANDON WAY STE B
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City | MT STERLING
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State | KY
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Zip | 40353-8405
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Country | US
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Telephone | 859-498-9393
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Fax | 859-498-9864
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Provider Business Mailing Address
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Address Line | 601 PERIMETER DR STE 200
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City | LEXINGTON
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State | KY
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Zip | 40517-4121
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Country | US
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Telephone | 859-278-9393
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Fax | 859-278-0923
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Authorized Official
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Title or Position | OWNER/MD
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Name | DR. JOHANNES C EVANS
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Credential | MD
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Telephone | 859-278-9393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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