Provider Demographics
NPI:1487674719
Name:MUSICK, JOHN E (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:MUSICK
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 1:104 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8842
Mailing Address - Country:US
Mailing Address - Phone:859-887-2441
Mailing Address - Fax:859-885-3323
Practice Address - Street 1:104 FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8842
Practice Address - Country:US
Practice Address - Phone:859-887-2441
Practice Address - Fax:859-885-3323
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0840DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77008407Medicaid
KY0968700004Medicare NSC
KY77008407Medicaid
KY9358802Medicare PIN