Provider Demographics
NPI:1386839702
Name:JAMES M. ERNST, O.D., P.S.C
Entity Type:Organization
Organization Name:JAMES M. ERNST, O.D., P.S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MAXWELL
Authorized Official - Last Name:ERNST
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-635-7600
Mailing Address - Street 1:7517 ALEXANDRIA PIKE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:KY
Mailing Address - Zip Code:41001-1051
Mailing Address - Country:US
Mailing Address - Phone:859-635-7600
Mailing Address - Fax:859-635-0900
Practice Address - Street 1:7517 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:KY
Practice Address - Zip Code:41001-1051
Practice Address - Country:US
Practice Address - Phone:859-635-7600
Practice Address - Fax:859-635-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1077DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77010775Medicaid
T54722Medicare UPIN
KY77010775Medicaid
KY4715170001Medicare NSC