Provider Demographics
NPI:1003155565
Name:RATLIFF, DAVID ROLAND (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ROLAND
Last Name:RATLIFF
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3469 N MAYO TRL
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3265
Mailing Address - Country:US
Mailing Address - Phone:606-437-7702
Mailing Address - Fax:606-437-2307
Practice Address - Street 1:3469 N MAYO TRL
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3265
Practice Address - Country:US
Practice Address - Phone:606-437-7702
Practice Address - Fax:606-437-2307
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY712156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician