Provider Demographics
NPI:1790700755
Name:TAYLOR, GREGORY E (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:E
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N MAIN CROSS ST
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-1361
Mailing Address - Country:US
Mailing Address - Phone:606-849-2349
Mailing Address - Fax:606-849-2349
Practice Address - Street 1:104 N MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-1361
Practice Address - Country:US
Practice Address - Phone:606-849-2349
Practice Address - Fax:606-849-2349
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1088DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77010882Medicaid
KY1436702Medicare ID - Type Unspecified
KYT54116Medicare UPIN