Provider Demographics
NPI:1750444212
Name:HERRON, JULIE A (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:HERRON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:STENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2408 LOST WILLOW CT
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048-7393
Mailing Address - Country:US
Mailing Address - Phone:859-384-2761
Mailing Address - Fax:
Practice Address - Street 1:6711 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:KY
Practice Address - Zip Code:41001-1025
Practice Address - Country:US
Practice Address - Phone:859-635-0948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1491DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77000172Medicaid
KY000000274452OtherANTHEM PIN
KY49287OtherDAVIS ID
KYK1491EOtherHUMANA ID
KY24453OtherSPECTERA ID
KY22-02615OtherUNITED HEALTHCARE ID
KY1930301Medicare ID - Type Unspecified
KY22-02615OtherUNITED HEALTHCARE ID