Provider Demographics
NPI:1861687048
Name:NEW LEXINGTON CLINIC, PSC
Entity Type:Organization
Organization Name:NEW LEXINGTON CLINIC, PSC
Other - Org Name:GEORGETOWN OPTOMETRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-258-4101
Mailing Address - Street 1:PO BOX 11790
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40578-1790
Mailing Address - Country:US
Mailing Address - Phone:859-258-6000
Mailing Address - Fax:859-258-6123
Practice Address - Street 1:1002 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1463
Practice Address - Country:US
Practice Address - Phone:502-868-0422
Practice Address - Fax:502-867-1967
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW LEXINGTON CLINIC, PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-11
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77902674Medicaid
KY2257Medicare PIN
KY0455510001Medicare NSC