Provider Demographics
NPI:1164611547
Name:SOUTH HILL EYE CARE, PLLC
Entity Type:Organization
Organization Name:SOUTH HILL EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:SPEAR
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:859-259-3768
Mailing Address - Street 1:535 SOUTH UPPER STREET
Mailing Address - Street 2:SUITE 195
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508
Mailing Address - Country:US
Mailing Address - Phone:859-259-3768
Mailing Address - Fax:859-281-9582
Practice Address - Street 1:535 S UPPER ST
Practice Address - Street 2:SUITE 195
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2935
Practice Address - Country:US
Practice Address - Phone:859-259-3768
Practice Address - Fax:859-281-9582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15652DT302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY=========OtherTAX ID FOR ORGANIZATION
KY0600146001Medicare NSC