Provider Demographics
NPI:1710043393
Name:KENTUCKY EYE CARE PSC
Entity Type:Organization
Organization Name:KENTUCKY EYE CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:IHNEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-896-5750
Mailing Address - Street 1:13 VILLAGE PLZ
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-1745
Mailing Address - Country:US
Mailing Address - Phone:502-633-0829
Mailing Address - Fax:502-633-0516
Practice Address - Street 1:13 VILLAGE PLZ
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1745
Practice Address - Country:US
Practice Address - Phone:502-633-0829
Practice Address - Fax:502-633-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100023950AMedicaid