Provider Demographics
NPI:1578538120
Name:TAYLOR, EMILY B (OD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:B
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 E ARCH ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-2102
Mailing Address - Country:US
Mailing Address - Phone:270-821-2862
Mailing Address - Fax:270-825-2200
Practice Address - Street 1:344 E ARCH ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2102
Practice Address - Country:US
Practice Address - Phone:270-821-2862
Practice Address - Fax:270-825-2200
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1137DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77011377Medicaid
KY0702701Medicare ID - Type Unspecified
KY1174651129Medicare NSC
KY77011377Medicaid