Provider Demographics
NPI:1275681280
Name:NORDIN EYE CENTER, PSC
Entity Type:Organization
Organization Name:NORDIN EYE CENTER, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-349-2020
Mailing Address - Street 1:120 AMANDA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALYERSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41465
Mailing Address - Country:US
Mailing Address - Phone:606-349-2020
Mailing Address - Fax:606-349-6773
Practice Address - Street 1:120 AMANDA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465
Practice Address - Country:US
Practice Address - Phone:606-349-2020
Practice Address - Fax:606-349-6773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1243DT152W00000X
KY1176DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77011765Medicaid
KY77012433Medicaid
KY77902047Medicaid
KY9317902Medicare ID - Type UnspecifiedDR. KIM NORDIN
0475930001Medicare NSC
KYU17287Medicare UPIN
KY77902047Medicaid
KY77012433Medicaid
KYU33748Medicare UPIN