Provider Demographics
NPI:1245204304
Name:MORRIS, LAUREL (OD)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:
Other - Last Name:VAN HORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-0256
Mailing Address - Country:US
Mailing Address - Phone:270-527-7421
Mailing Address - Fax:270-527-3118
Practice Address - Street 1:109 W 5TH ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-1123
Practice Address - Country:US
Practice Address - Phone:270-527-7421
Practice Address - Fax:270-527-3118
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1469DT174400000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77014694Medicaid
KYU78405OtherBLUEGRASS FAMILY HEALTH
KY419242OtherHEALTHLINK
KY000000200887OtherBLUE CROSS BLUE SHIELD
KY7541029OtherAETNA
KYMV0441181OtherDEA
KY77014694Medicaid
KY0413360001Medicare NSC
KY419242OtherHEALTHLINK