Provider Demographics
NPI:1881636470
Name:KENTUCKY INSTITUTE FOR EYE HEALTH & SURGERY
Entity Type:Organization
Organization Name:KENTUCKY INSTITUTE FOR EYE HEALTH & SURGERY
Other - Org Name:KENTUCKY EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:859-278-9393
Mailing Address - Street 1:601 PERIMETER DR
Mailing Address - Street 2:STE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4121
Mailing Address - Country:US
Mailing Address - Phone:859-278-9393
Mailing Address - Fax:859-278-0923
Practice Address - Street 1:65 E CITY DAM RD
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-4620
Practice Address - Country:US
Practice Address - Phone:859-278-9393
Practice Address - Fax:859-278-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
KY32182332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100226610Medicaid
KY65912479Medicaid
KYCA7200Medicare PIN
KY0968700006Medicare NSC
KY7100226610Medicaid