Provider Demographics
NPI:1235869819
Name:SEXTON, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:SEXTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 N MAYO TRL
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1823
Mailing Address - Country:US
Mailing Address - Phone:606-788-7275
Mailing Address - Fax:606-788-7342
Practice Address - Street 1:470 N MAYO TRL
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1823
Practice Address - Country:US
Practice Address - Phone:606-788-7275
Practice Address - Fax:606-788-7342
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY110316156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician