=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568537959
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY EYE CLINIC AND EDUCATIONAL FOUNDATION, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 E. MUHAMMAD ALI BLVD.
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40202-1594
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-852-7665
-----------------------------------------------------
Fax | 502-852-4947
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 E. MUHAMMAD ALI BLVD.
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40202-1594
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-852-7665
-----------------------------------------------------
Fax | 502-852-4947
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOERN B. SOLTAU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 502-852-7665
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------