Provider Demographics
NPI:1346528049
Name:MCNULTY, AARON C (OD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:C
Last Name:MCNULTY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 LIME KILN LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3425
Mailing Address - Country:US
Mailing Address - Phone:270-929-5517
Mailing Address - Fax:
Practice Address - Street 1:2420 LIME KILN LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3425
Practice Address - Country:US
Practice Address - Phone:502-426-5000
Practice Address - Fax:502-426-2377
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1903DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100221010Medicaid
KYK125601Medicare PIN
KYK052320Medicare PIN