Provider Demographics
NPI:1609877083
Name:JOHN KENYON EYE CENTER
Entity Type:Organization
Organization Name:JOHN KENYON EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-258-3026
Mailing Address - Street 1:1305 WALL ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3853
Mailing Address - Country:US
Mailing Address - Phone:812-288-9011
Mailing Address - Fax:812-288-7479
Practice Address - Street 1:1305 WALL ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3853
Practice Address - Country:US
Practice Address - Phone:812-288-9011
Practice Address - Fax:812-288-7479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025213207W00000X
KY15811207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty