Provider Demographics
NPI:1144344110
Name:CORBIN, CYNTHIA ELAM (OD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ELAM
Last Name:CORBIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HAPPY DAY RD
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-7255
Mailing Address - Country:US
Mailing Address - Phone:606-546-3160
Mailing Address - Fax:
Practice Address - Street 1:112 N ALLISON AVE
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1335
Practice Address - Country:US
Practice Address - Phone:606-546-2200
Practice Address - Fax:606-546-2709
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1509DT152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000351743OtherANTHEM BC AND BS
KY77000453Medicaid
KY428-93OtherBLUEGRASS FAMILY HEALTH
KY000000351743OtherANTHEM BC AND BS
KY00431Medicare PIN