Provider Demographics
NPI:1003880212
Name:BASSETT, LAURA LEA (OD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEA
Last Name:BASSETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LEA
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:7635 SHELBYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5409
Mailing Address - Country:US
Mailing Address - Phone:502-423-8500
Mailing Address - Fax:
Practice Address - Street 1:7635 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5409
Practice Address - Country:US
Practice Address - Phone:502-423-8500
Practice Address - Fax:502-584-2365
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1397DT152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00850450OtherRR MEDICARE
9010611Medicare PIN
76107Medicare UPIN
0191960001Medicare NSC