Provider Demographics
NPI:1689874885
Name:NGOC DO BIZZELL OD, PSC
Entity Type:Organization
Organization Name:NGOC DO BIZZELL OD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NGOC
Authorized Official - Middle Name:C
Authorized Official - Last Name:DO-BIZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-222-2889
Mailing Address - Street 1:1015 NEW MOODY LN
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-9142
Mailing Address - Country:US
Mailing Address - Phone:502-222-2889
Mailing Address - Fax:502-222-5274
Practice Address - Street 1:1015 NEW MOODY LN
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9142
Practice Address - Country:US
Practice Address - Phone:502-222-2889
Practice Address - Fax:502-222-5274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1582DTKY152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1215006770OtherNPI
KY77001022Medicaid
KY77001022Medicaid