Provider Demographics
NPI:1265165427
Name:JASINSKI, AMY S (APPRENTICE OPTICIAN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:JASINSKI
Suffix:
Gender:F
Credentials:APPRENTICE OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-8694
Mailing Address - Country:US
Mailing Address - Phone:502-243-9767
Mailing Address - Fax:502-243-9768
Practice Address - Street 1:6501 VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-8694
Practice Address - Country:US
Practice Address - Phone:502-243-9767
Practice Address - Fax:502-243-9768
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY274158156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician