MEDICARE: BABY EYES LACTATION CONSULTING LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1093360810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BABY EYES LACTATION CONSULTING LLC

Provider Business Mailing Address
First Line	:	5615 JUNIPER BEACH RD
Second Line	:
City	:	PROSPECT
State	:	KY
Zip	:	40059-9684
Country	:	US
Telephone Number	:	502-773-3965
Fax Number	:	502-443-0283

Provider Business Practice Location Address
First Line	:	5615 JUNIPER BEACH RD
Second Line	:
City	:	PROSPECT
State	:	KY
Zip	:	40059-9684
Country	:	US
Telephone Number	:	502-773-3965
Fax Number	:	502-443-0283

Authorized Official
Title or Position	:	OWNER
Name	:	AMANDA GAIL AUBREY
Credential	:	APRN, IBCLC
Telephone Number	:	502-773-3965

Provider Enumeration Date	:	08/08/2019
Last Update Date	:	04/10/2020

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