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General NPI Number Information
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NPI Number | 1932929973
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Entity Type | Organization
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Legal Business Name | MMY LOUISVILLE
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 403 WASHINGTON ST
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City | SHELBYVILLE
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State | KY
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Zip | 40065-1127
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Country | US
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Telephone | 502-398-3937
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1374
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City | SHELBYVILLE
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State | KY
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Zip | 40066-1374
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. MATTHEW MOONEY
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Credential |
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Telephone | 502-538-4362
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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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