Provider Demographics
NPI:1013100841
Name:JESSAMINE EYE CENTER, P.L.L.C.
Entity Type:Organization
Organization Name:JESSAMINE EYE CENTER, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-881-1400
Mailing Address - Street 1:100 JOHN SUTHERLAND DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-2424
Mailing Address - Country:US
Mailing Address - Phone:859-881-1400
Mailing Address - Fax:859-881-3489
Practice Address - Street 1:100 JOHN SUTHERLAND DR
Practice Address - Street 2:SUITE 3
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-2424
Practice Address - Country:US
Practice Address - Phone:859-881-1400
Practice Address - Fax:859-881-3489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35266207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000240538OtherANTHEM BC/BS
KY7284OtherMEDICARE GROUP NUMBER
KYAETNAOther7750007
KY64007511Medicaid
KY0728401Medicare PIN
KYH01312Medicare UPIN