Provider Demographics
NPI:1245269539
Name:EYE INSTITUTE OF KENTUCKY
Entity type:Organization
Organization Name:EYE INSTITUTE OF KENTUCKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:N
Authorized Official - Last Name:PERREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-881-0022
Mailing Address - Street 1:8076 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7930
Mailing Address - Country:US
Mailing Address - Phone:877-881-0022
Mailing Address - Fax:702-543-0314
Practice Address - Street 1:1800 OLD LEBANON RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9663
Practice Address - Country:US
Practice Address - Phone:270-789-2023
Practice Address - Fax:270-465-4220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5035Medicare PIN
KY0683230001Medicare NSC