Provider Demographics
NPI:1376537795
Name:WARD JR, HOMER ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:HOMER
Middle Name:ANDREW
Last Name:WARD JR
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 1:411 PARK PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-5449
Mailing Address - Country:US
Mailing Address - Phone:270-683-2020
Mailing Address - Fax:270-686-0000
Practice Address - Street 1:411 PARK PLAZA DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-5449
Practice Address - Country:US
Practice Address - Phone:270-683-2020
Practice Address - Fax:270-686-0000
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0790DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77007904Medicaid
KYT54578Medicare UPIN
KY0789902Medicare PIN