Provider Demographics
NPI:1942347703
Name:PURKISS, TODD JORDAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:JORDAN
Last Name:PURKISS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N EAGLE CREEK DR
Mailing Address - Street 2:STE 500
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1827
Mailing Address - Country:US
Mailing Address - Phone:859-263-3900
Mailing Address - Fax:859-263-3757
Practice Address - Street 1:120 N EAGLE CREEK DR
Practice Address - Street 2:STE 500
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1827
Practice Address - Country:US
Practice Address - Phone:859-263-3900
Practice Address - Fax:859-263-3757
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00297207W00000X
KY42434207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY710081470Medicaid
OH0117684Medicaid
KYK171660Medicare PIN
KY0241217Medicare PIN