Provider Demographics
NPI:1972550291
Name:VANCE, KATHY J (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:J
Last Name:VANCE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1332
Mailing Address - Country:US
Mailing Address - Phone:502-585-2020
Mailing Address - Fax:502-585-1797
Practice Address - Street 1:120 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1332
Practice Address - Country:US
Practice Address - Phone:502-585-2020
Practice Address - Fax:502-585-1797
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1051DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY410036412OtherRAILROAD MEDICARE
KY77010510Medicaid
KY410036412OtherRAILROAD MEDICARE
KY77010510Medicaid