Provider Demographics
NPI:1659156677
Name:EYEMAX REGIONAL PLLC
Entity Type:Organization
Organization Name:EYEMAX REGIONAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER MATTSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-787-0936
Mailing Address - Street 1:3070 HARRODSBURG RD STE 130
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2764
Mailing Address - Country:US
Mailing Address - Phone:859-787-0936
Mailing Address - Fax:859-201-1207
Practice Address - Street 1:3070 HARRODSBURG RD STE 130
Practice Address - Street 2:TELEHEALTH ONLY
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2764
Practice Address - Country:US
Practice Address - Phone:859-787-0936
Practice Address - Fax:859-201-1207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty