| |
4402 Churchman Ave, Ste 306, Louisville, KY 40215-3101 | |
(502) 367-6137 | |
(502) 367-4020 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 4402 Churchman Ave, Louisville, Kentucky |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1780047456 | NPI | - | NPPES |
65917833 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 1994DT (Kentucky) | Secondary |
207W00000X | Ophthalmology | 35792 (Kentucky) | Primary |
207W00000X | Ophthalmology | 24245 (Kentucky) | Secondary |
Mailing Address | Practice Location Address |
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6400 Westwind Way, Crestwood, KY 40014-6773 Ph: (502) 243-2227 | 4402 Churchman Ave, Ste 306, Louisville, KY 40215-3101 Ph: (502) 367-6137 |