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NPI Code Detail

MEDICARE: JOHN FREDRICK LITKE OD

MEDICARE: JOHN FREDRICK LITKE OD
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
1152W00000XOptometristK0992KY

General Provider Information

NPI Number : 1912903634
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN FREDRICK LITKE OD
Provider Business Mailing Address
First Line : 1997 BARRETT CT
Second Line :
City : HENDERSON
State : KY
Zip : 42420-2667
Country : US
Telephone Number : 270-826-9966
Fax Number : 270-827-1206
Provider Business Practice Location Address
First Line : 1997 BARRETT CT
Second Line :
City : HENDERSON
State : KY
Zip : 42420-2667
Country : US
Telephone Number : 270-826-9966
Fax Number : 270-827-1206
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 07/08/2007

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