Provider Demographics
NPI:1639380793
Name:LISA SLOAN WOODY OD PSC BARDSTOWN EYE CARE
Entity Type:Organization
Organization Name:LISA SLOAN WOODY OD PSC BARDSTOWN EYE CARE
Other - Org Name:BARDSTOWN EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:SLOAN
Authorized Official - Last Name:WOODY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-348-8584
Mailing Address - Street 1:311 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1507
Mailing Address - Country:US
Mailing Address - Phone:502-348-8584
Mailing Address - Fax:502-348-4695
Practice Address - Street 1:311 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1507
Practice Address - Country:US
Practice Address - Phone:502-348-8584
Practice Address - Fax:502-348-4695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1249DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3204Medicare PIN
KY0531500001Medicare NSC