Provider Demographics
NPI:1437151099
Name:TAUSTINE, LLOYD ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:ROSS
Last Name:TAUSTINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 DUTCHMANS PKWY STE 125
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3342
Mailing Address - Country:US
Mailing Address - Phone:502-896-8700
Mailing Address - Fax:502-896-0813
Practice Address - Street 1:1169 EASTERN PKWY STE 1211
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1462
Practice Address - Country:US
Practice Address - Phone:502-896-8700
Practice Address - Fax:502-896-0813
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19646207W00000X
IN28394207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
100259770AOtherMEDICAID IN MADISON OFFIC
I005632OtherTRICARE INDIANA OFFICE
K001342OtherTRICARE KENTUCKY OFFICE
IN000000042393OtherANTHEM
100259770BOtherMEDICAID IN LOUISVILLE OF
KY180012783OtherMEDICARE RAILROAD
KY1052110Medicaid
IN180004025OtherMEDICARE RAILROAD
917333OtherBLOCK VISION
0800022OtherUNITED HEALTHCARE
KY000000062217OtherANTHEM
4012921OtherAETNA
KY64196462Medicaid
K001342OtherTRICARE KENTUCKY OFFICE
KY64196462Medicaid
KY1052110Medicaid