Provider Demographics
NPI:1689736506
Name:ERNST, JAMES MAXWELL (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MAXWELL
Last Name:ERNST
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7517 ALEXANDRIA PIKE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:KY
Mailing Address - Zip Code:41001-1051
Mailing Address - Country:US
Mailing Address - Phone:859-635-7600
Mailing Address - Fax:859-635-0900
Practice Address - Street 1:7517 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:KY
Practice Address - Zip Code:41001-1051
Practice Address - Country:US
Practice Address - Phone:859-635-7600
Practice Address - Fax:859-635-0900
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1077DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77010775Medicaid
KY77010775Medicaid
KY4715170001Medicare NSC
00424001Medicare PIN