Provider Demographics
NPI:1134155047
Name:THE OPHTHALMOLOGY GROUP LLP
Entity type:Organization
Organization Name:THE OPHTHALMOLOGY GROUP LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-442-1671
Mailing Address - Street 1:1900 BROADWAY ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7158
Mailing Address - Country:US
Mailing Address - Phone:270-443-2020
Mailing Address - Fax:
Practice Address - Street 1:1900 BROADWAY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7158
Practice Address - Country:US
Practice Address - Phone:270-443-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE OPHTHALMOLOGY GROUP LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-23
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0254750006Medicare NSC