Provider Demographics
NPI:1639365224
Name:ROBERT G. KINKER, PSC
Entity Type:Organization
Organization Name:ROBERT G. KINKER, PSC
Other - Org Name:EYE CARE FOR KENTUCKY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:KINKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-223-8258
Mailing Address - Street 1:PO BOX 4265
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40604-4265
Mailing Address - Country:US
Mailing Address - Phone:502-223-8258
Mailing Address - Fax:502-875-9481
Practice Address - Street 1:102 DIAGNOSTIC DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-6524
Practice Address - Country:US
Practice Address - Phone:502-223-8258
Practice Address - Fax:502-875-9481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1626DT152W00000X
KY20615207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65936981Medicaid
KY65936981Medicaid