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General NPI Number Information
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NPI Number | 1396763074
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Entity Type | Organization
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Legal Business Name | EYE CENTERS OF LOUISVILLE,P.S.C.
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1400 POPLAR LEVEL RD
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City | LOUISVILLE
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State | KY
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Zip | 40217-1309
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Country | US
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Telephone | 502-214-3390
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Fax | 502-637-1550
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Provider Business Mailing Address
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Address Line | 1400 POPLAR LEVEL RD
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City | LOUISVILLE
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State | KY
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Zip | 40217-1309
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Country | US
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Telephone | 502-214-3390
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Fax | 502-637-1550
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Authorized Official
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Title or Position | C.E.O.
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Name | DR. DONALD W BENNETT
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Credential | M.D.
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Telephone | 502-214-3381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 300133
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License Number State | KY
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