Provider Demographics
NPI:1598189516
Name:MY EYE DOCTOR PLUS
Entity Type:Organization
Organization Name:MY EYE DOCTOR PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OD
Authorized Official - Prefix:
Authorized Official - First Name:SIJIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:NOTH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-351-8660
Mailing Address - Street 1:6421 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-3040
Mailing Address - Country:US
Mailing Address - Phone:270-351-8660
Mailing Address - Fax:270-351-8713
Practice Address - Street 1:6421 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-3040
Practice Address - Country:US
Practice Address - Phone:270-351-8660
Practice Address - Fax:270-351-8713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK127290Medicare PIN