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General NPI Number Information
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NPI Number | 1962087429
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Entity Type | Organization
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Legal Business Name | PDS CONSULTANTS OPTICAL LLC
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Dates
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Enumeration Date | 03/16/2021
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 4917 DIXIE HWY STE H
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City | LOUISVILLE
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State | KY
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Zip | 40216-2565
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Country | US
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Telephone | 502-447-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 4036 DUTCHMANS LN
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City | LOUISVILLE
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State | KY
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Zip | 40207-4704
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Country | US
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Telephone | 502-895-2020
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Fax |
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Authorized Official
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Title or Position | COO
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Name | STEVE BAKER
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Credential |
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Telephone | 502-897-1656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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