Provider Demographics
NPI:1295948164
Name:KENTUCKY INSTITUTE FOR EYE HEALTH AND SURGERY
Entity type:Organization
Organization Name:KENTUCKY INSTITUTE FOR EYE HEALTH AND SURGERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOODWORTH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:859-278-9393
Mailing Address - Street 1:1401 HARRODSBURG RD
Mailing Address - Street 2:B75
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3751
Mailing Address - Country:US
Mailing Address - Phone:859-278-9393
Mailing Address - Fax:859-278-0923
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:B75
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-278-9393
Practice Address - Fax:859-278-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65912776Medicaid
KY65922288Medicaid
KY65937435Medicaid
KY65912479Medicaid
KY65912529Medicaid
KY65912461Medicaid
KY77903540Medicaid
KY65912511Medicaid
KY65912461Medicaid
KY65922288Medicaid
KY65912529Medicaid
KY65912479Medicaid
KY8257Medicare PIN
KY2686Medicare ID - Type UnspecifiedGROUP NUMBER
KY65937435Medicaid
KY77903540Medicaid
KY3546Medicare ID - Type UnspecifiedGROUP NUMBER
KY2140Medicare ID - Type UnspecifiedGROUP NUMBER