Provider Demographics
NPI:1679790026
Name:CENTRAL KENTUCKY EYE ASSOCIATES PSC
Entity Type:Organization
Organization Name:CENTRAL KENTUCKY EYE ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-623-2020
Mailing Address - Street 1:238 GERI LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2304
Mailing Address - Country:US
Mailing Address - Phone:859-623-2020
Mailing Address - Fax:859-623-0346
Practice Address - Street 1:238 GERI LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2304
Practice Address - Country:US
Practice Address - Phone:859-623-2020
Practice Address - Fax:859-623-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2013-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18437207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC65736Medicare UPIN
KY0207202Medicare PIN