Provider Demographics
NPI:1689675159
Name:DOWNEY, MAX MITCHELL (OD)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:MITCHELL
Last Name:DOWNEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BURKESVILLE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1921
Mailing Address - Country:US
Mailing Address - Phone:270-384-6043
Mailing Address - Fax:270-384-0672
Practice Address - Street 1:301 BURKESVILLE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1921
Practice Address - Country:US
Practice Address - Phone:270-384-6043
Practice Address - Fax:270-384-0672
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY979DT152W00000X
KYKY979DT332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1841253424OtherGROUP NPI
KY77009793Medicaid
KY0738910001OtherJURISDICTION B DMEMAC
KY77904126Medicaid
KY0738910001OtherJURISDICTION B DMEMAC
KY77009793Medicaid
KY9801Medicare ID - Type UnspecifiedGROUP