Provider Demographics
NPI:1003060930
Name:KENTUCKY OPTICAL COMPANY LLC
Entity Type:Organization
Organization Name:KENTUCKY OPTICAL COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSHIL
Authorized Official - Middle Name:V
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-368-3937
Mailing Address - Street 1:4940 HAZELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-1270
Mailing Address - Country:US
Mailing Address - Phone:502-367-2010
Mailing Address - Fax:502-368-0231
Practice Address - Street 1:4940 HAZELWOOD AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-1270
Practice Address - Country:US
Practice Address - Phone:502-367-2010
Practice Address - Fax:502-368-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier