Provider Demographics
NPI:1184605685
Name:DOERR, MOLLY WEST (OD)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:WEST
Last Name:DOERR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:WEST DOERR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1800 OLD LEBANON RD.
Mailing Address - Street 2:EYE INSTITUTE OF KENTUCKY
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718
Mailing Address - Country:US
Mailing Address - Phone:270-789-2023
Mailing Address - Fax:270-465-5361
Practice Address - Street 1:1800 OLD LEBANON RD.
Practice Address - Street 2:EYE INSTITUTE OF KENTUCKY
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718
Practice Address - Country:US
Practice Address - Phone:270-789-2023
Practice Address - Fax:270-465-5361
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0872DT152W00000X
KY872DT152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0178520001OtherPALMETTO GBA
32055OtherDAVIS VISION
611139709OtherUNITED HEALTH CARE
611139709OtherMED BEN
911199OtherBLOCK VISION
MD17067OtherSPECTERA
00000000049084OtherANTHEM
410012251OtherRAILROAD MEDICARE
VF19372OtherVISION CARE ADVANTAGE
15300OtherALTERNATIVE HEALTH
611139709OtherVISION CARE PLAN
KY77008720Medicaid
375807OtherCLARITY VISION
5025326332OtherVISION SERVICE PLAN
45001526OtherEPSDT MEDICAID KY
KY0872OtherEYE MED VISION CARE
4643655OtherAETNA
611139709AOtherHUMANA
T92112Medicare UPIN
32055OtherDAVIS VISION