MEDICARE: JESSAMINE EYE CENTER, P.L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	35266	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	7284	OTHER	KY	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000240538	OTHER	KY	ANTHEM BC/BS
3	AETNA	OTHER	KY	7750007
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013100841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSAMINE EYE CENTER, P.L.L.C.

Provider Business Mailing Address
First Line	:	100 JOHN SUTHERLAND DR
Second Line	:	SUITE 3
City	:	NICHOLASVILLE
State	:	KY
Zip	:	40356-2424
Country	:	US
Telephone Number	:	859-881-1400
Fax Number	:	859-881-3489

Provider Business Practice Location Address
First Line	:	100 JOHN SUTHERLAND DR
Second Line	:	SUITE 3
City	:	NICHOLASVILLE
State	:	KY
Zip	:	40356-2424
Country	:	US
Telephone Number	:	859-881-1400
Fax Number	:	859-881-3489

Authorized Official
Title or Position	:	PHYSICIAN / OWNER
Name	:	DR. LINDA KATHLEEN KATZ
Credential	:	M.D.
Telephone Number	:	859-881-1400

Provider Enumeration Date	:	08/24/2007
Last Update Date	:	08/24/2007

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Directions to “JESSAMINE EYE CENTER, P.L.L.C. ” Practice Location

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