Provider Demographics
NPI:1619033131
Name:KENTUCKY INSTITUTE FOR EYE HEALTH AND SURGERY
Entity Type:Organization
Organization Name:KENTUCKY INSTITUTE FOR EYE HEALTH AND SURGERY
Other - Org Name:KY EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOODWORTH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:859-278-9393
Mailing Address - Street 1:1401 HARRODSBURG RD STE B75
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-1724
Mailing Address - Country:US
Mailing Address - Phone:859-278-9393
Mailing Address - Fax:859-278-0923
Practice Address - Street 1:65 EAST CITY DAM RD
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-4620
Practice Address - Country:US
Practice Address - Phone:606-528-9393
Practice Address - Fax:606-528-9397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65912479Medicaid
KY2139Medicare ID - Type UnspecifiedGROUP NUMBER