Provider Demographics
NPI:1225022593
Name:HARNED, ANNA L (OD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:L
Last Name:HARNED
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 1:2525 ELIZABETHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-9120
Mailing Address - Country:US
Mailing Address - Phone:270-287-2020
Mailing Address - Fax:270-259-5660
Practice Address - Street 1:2525 ELIZABETHTOWN RD
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-9120
Practice Address - Country:US
Practice Address - Phone:270-287-2020
Practice Address - Fax:270-259-5660
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1375DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000351970OtherANTHEM BCBS
KYP00198146OtherRR MEDICARE
KY1375DTOtherOD LICENSE NUMBER
KY77013753Medicaid
KYP00198146OtherRR MEDICARE
KY77013753Medicaid
V52387Medicare UPIN