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General NPI Number Information
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NPI Number | 1609930791
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Entity Type | Organization
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Legal Business Name | CASAK WOODHILL LLC
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1555 E NEW CIRCLE RD SUITE #146
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City | LEXINGTON
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State | KY
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Zip | 40509-1043
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Country | US
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Telephone | 859-266-3003
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Fax | 859-266-9504
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Provider Business Mailing Address
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Address Line | 1555 E NEW CIRCLE RD SUITE #146
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City | LEXINGTON
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State | KY
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Zip | 40509-1043
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Country | US
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Telephone | 859-266-3003
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Fax | 859-266-9504
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | STEVEN AMBROSE KLECKER
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Credential | OD
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Telephone | 859-266-3003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 244184
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License Number State | KY
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