Provider Demographics
NPI:1295817682
Name:LANCE S FERGUSON MD PSC
Entity Type:Organization
Organization Name:LANCE S FERGUSON MD PSC
Other - Org Name:COMMONWEALTH EYE SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SURGICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-224-2655
Mailing Address - Street 1:2353 ALEXANDRIA DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3264
Mailing Address - Country:US
Mailing Address - Phone:859-224-2655
Mailing Address - Fax:859-223-7147
Practice Address - Street 1:2353 ALEXANDRIA DR
Practice Address - Street 2:SUITE 260
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3264
Practice Address - Country:US
Practice Address - Phone:859-224-2655
Practice Address - Fax:859-223-7147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65923195Medicaid
KY77902245Medicaid
KY0945Medicare PIN