Provider Demographics
NPI:1073553228
Name:NOTH, SIJIA SCARLETT (OD)
Entity Type:Individual
Prefix:
First Name:SIJIA
Middle Name:SCARLETT
Last Name:NOTH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SIJIA
Other - Middle Name:SCARLETT
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:6421 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-3040
Mailing Address - Country:US
Mailing Address - Phone:270-351-8660
Mailing Address - Fax:270-351-8713
Practice Address - Street 1:6421 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-3040
Practice Address - Country:US
Practice Address - Phone:270-351-8660
Practice Address - Fax:270-351-8713
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1718DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100108380Medicaid
KY00984004Medicare PIN
KY00985004Medicare PIN
KYK129210Medicare PIN