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General NPI Number Information
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NPI Number | 1902587660
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Entity Type | Organization
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Legal Business Name | BLUEGRASS VISION GROUP OF HAMBURG PLLC
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Dates
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Enumeration Date | 07/26/2023
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 2716 OLD ROSEBUD RD STE 130
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City | LEXINGTON
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State | KY
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Zip | 40509-8007
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Country | US
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Telephone | 859-327-3701
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Fax | 859-327-3703
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Provider Business Mailing Address
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Address Line | 2716 OLD ROSEBUD RD STE 130
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City | LEXINGTON
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State | KY
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Zip | 40509-8007
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Country | US
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Telephone | 859-327-3701
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Fax | 859-327-3703
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN COLEMAN
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Credential | OD
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Telephone | 859-498-4800
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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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