Provider Demographics
NPI:1043240757
Name:MCENTIRE, RENEE S (OD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:S
Last Name:MCENTIRE
Suffix:
Gender:
Credentials:OD
Other - Prefix:DR
Other - First Name:RENEE
Other - Middle Name:S
Other - Last Name:COMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1536 STORY AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1738
Mailing Address - Country:US
Mailing Address - Phone:502-589-1500
Mailing Address - Fax:502-589-1556
Practice Address - Street 1:1536 STORY AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1738
Practice Address - Country:US
Practice Address - Phone:502-589-1500
Practice Address - Fax:502-589-1556
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1678DT152W00000X
IN18003404A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN18003404AOtherOD LICENSE NUMBER
KY000000531030OtherANTHEM BCBS
KY1678DTOtherOD LICENSE NUMBER
IN200854690Medicaid
KY7100025620Medicaid
IN221390EMedicare PIN
KY7100025620Medicaid
KY5419240002Medicare NSC
KY1678DTOtherOD LICENSE NUMBER
KY0941016Medicare PIN