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NPI Code Detail

MEDICARE: DR. RENEE S MCENTIRE O.D.

MEDICARE: DR. RENEE S MCENTIRE O.D.
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
1152W00000XOptometrist1678DTKY
2152W00000XOptometrist18003404AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
118003404AOTHERINOD LICENSE NUMBER
2000000531030OTHERKYANTHEM BCBS
31678DTOTHERKYOD LICENSE NUMBER
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043240757
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RENEE S MCENTIRE O.D.
Provider Business Mailing Address
First Line : 1536 STORY AVE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40206-1738
Country : US
Telephone Number : 502-589-1500
Fax Number : 502-589-1556
Provider Business Practice Location Address
First Line : 1536 STORY AVE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40206-1738
Country : US
Telephone Number : 502-589-1500
Fax Number : 502-589-1556
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2006
Last Update Date : 04/14/2025

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