Provider Demographics
NPI:1114200847
Name:MORSHEDI, AHMAD MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:MICHAEL
Last Name:MORSHEDI
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 1:2020 BASHFORD MANOR LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2114
Mailing Address - Country:US
Mailing Address - Phone:502-716-2020
Mailing Address - Fax:502-451-6884
Practice Address - Street 1:2020 BASHFORD MANOR LANE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218
Practice Address - Country:US
Practice Address - Phone:502-716-2020
Practice Address - Fax:502-451-6884
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2226152W00000X
KYKY2047DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1679016893Medicaid