Provider Demographics
NPI:1073792651
Name:MAROUDIS, SOCRATES (OD)
Entity Type:Individual
Prefix:
First Name:SOCRATES
Middle Name:
Last Name:MAROUDIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2607
Mailing Address - Country:US
Mailing Address - Phone:606-329-1404
Mailing Address - Fax:
Practice Address - Street 1:1201 13TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2607
Practice Address - Country:US
Practice Address - Phone:606-329-1404
Practice Address - Fax:606-325-7446
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1722DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist