Provider Demographics
NPI:1598717027
Name:THE OPHTHALMOLOGY GROUP, LLC
Entity Type:Organization
Organization Name:THE OPHTHALMOLOGY GROUP, LLC
Other - Org Name:EYECARE PARTNERS, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:GIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-442-7307
Mailing Address - Street 1:4630 VILLAGE SQUARE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7502
Mailing Address - Country:US
Mailing Address - Phone:270-442-1671
Mailing Address - Fax:270-442-7307
Practice Address - Street 1:4630 VILLAGE SQUARE DRIVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7502
Practice Address - Country:US
Practice Address - Phone:270-442-1671
Practice Address - Fax:270-442-7307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB5783OtherRAILROAD MEDICARE
KY7100053130Medicaid
=========OtherTRICARE
5440Medicare PIN
5842Medicare PIN