Provider Demographics
NPI:1336879444
Name:DINWIDDIE, LAURA NICOLE (LDO)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:NICOLE
Last Name:DINWIDDIE
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 NASHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:KY
Mailing Address - Zip Code:42134-6962
Mailing Address - Country:US
Mailing Address - Phone:270-586-0110
Mailing Address - Fax:270-586-0281
Practice Address - Street 1:1550 NASHVILLE RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134-6962
Practice Address - Country:US
Practice Address - Phone:270-586-0110
Practice Address - Fax:270-586-0281
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY245639156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician