Provider Demographics
NPI:1356513741
Name:REGINA COLEMAN COMPTON, O.D., PSC
Entity type:Organization
Organization Name:REGINA COLEMAN COMPTON, O.D., PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-432-3576
Mailing Address - Street 1:4219 N MAYO TRL
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3210
Mailing Address - Country:US
Mailing Address - Phone:606-432-3576
Mailing Address - Fax:606-432-7009
Practice Address - Street 1:4219 N MAYO TRL
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3210
Practice Address - Country:US
Practice Address - Phone:606-432-3576
Practice Address - Fax:606-432-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1313DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77000180Medicaid
KY77000180Medicaid
1796201Medicare PIN