Provider Demographics
NPI:1083149868
Name:RAY, KATE OLIVER (OD)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:OLIVER
Last Name:RAY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:ELISE
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2420 LIME KILN LN STE H
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3425
Mailing Address - Country:US
Mailing Address - Phone:502-426-5000
Mailing Address - Fax:
Practice Address - Street 1:2420 LIME KILN LN STE H
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222
Practice Address - Country:US
Practice Address - Phone:502-426-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2070DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK244380OtherMEDICARE