Provider Demographics
NPI:1750010096
Name:LACEFIELD, PAMELA KAY
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:KAY
Last Name:LACEFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SAM WALTON DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-9311
Mailing Address - Country:US
Mailing Address - Phone:270-726-8283
Mailing Address - Fax:270-726-9842
Practice Address - Street 1:120 SAM WALTON DR
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-9311
Practice Address - Country:US
Practice Address - Phone:270-726-8283
Practice Address - Fax:270-726-9842
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY110221156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician