Provider Demographics
NPI:1184626459
Name:LOUISVILLE OPTIQUE PLLC
Entity type:Organization
Organization Name:LOUISVILLE OPTIQUE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DAMON
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-587-8696
Mailing Address - Street 1:140 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:502-587-8696
Mailing Address - Fax:502-587-8165
Practice Address - Street 1:140 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:502-587-8696
Practice Address - Fax:502-587-8165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY13407OtherSPECTERA
KY017121OtherPASSPORT BLOCK VISION
KY22 00155OtherUNITED HEALTH CARE
KY2667754OtherAETNA
KYOP1650OtherEYEMED
KY16711OtherAVESIS
KY000000198613OtherANTHEM LOCATION
KY10670OtherCVC LOCATION
KY7989966OtherCIGNA
KY77903417Medicaid
KY1889601Medicare ID - Type UnspecifiedMEDICARE PROVIDER