Provider Demographics
NPI:1295257707
Name:SLAYDEN, KEITH R (OD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:R
Last Name:SLAYDEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 BLUEGRASS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1181
Mailing Address - Country:US
Mailing Address - Phone:502-364-0033
Mailing Address - Fax:502-361-4488
Practice Address - Street 1:1935 BLUEGRASS AVE STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1181
Practice Address - Country:US
Practice Address - Phone:502-214-3396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2074DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100499100Medicaid
IN300050542Medicaid