Provider Demographics
NPI:1205972056
Name:MILBY, MICHAEL A (OD PSC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:MILBY
Suffix:
Gender:M
Credentials:OD PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24635
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40524-4635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3180 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1596
Practice Address - Country:US
Practice Address - Phone:859-269-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 932 DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77009322Medicaid
KY42415OtherSPECTERA
KY000000321715OtherANTHEM BCBS
KY35630OtherAVESIS
KY5660OtherCHA
KYT54651OtherBLUEGRASS FAMILY HEALTH
KYT54651OtherBLUEGRASS FAMILY HEALTH
KY9153001Medicare ID - Type Unspecified