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General NPI Number Information
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NPI Number | 1508117326
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Entity Type | Organization
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Legal Business Name | KENTUCKY CENTER FOR RECONSTRUCTIVE OCULOPLASTIC LACRIMAL & ORBITAL SUR
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Dates
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Enumeration Date | 09/20/2012
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Last Update Date | 10/22/2012
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Provider Practice Location Address
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Address Line | 771 CORPORATE DR SUITE 460
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City | LEXINGTON
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State | KY
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Zip | 40503-5405
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Country | US
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Telephone | 859-219-0299
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Fax | 859-219-0699
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Provider Business Mailing Address
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Address Line | 771 CORPORATE DR SUITE 460
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City | LEXINGTON
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State | KY
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Zip | 40503-5405
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Country | US
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Telephone | 859-219-0299
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Fax | 859-219-0699
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/OWNER
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Name | DAVID E. COWEN
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Credential | M.D.
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Telephone | 859-219-0299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 26654
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License Number State | KY
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