Provider Demographics
NPI:1700881919
Name:ISERNHAGEN, RICKY D (MD)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:D
Last Name:ISERNHAGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:120 N EAGLE CREEK DR
Mailing Address - Street 2:STE 500
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1827
Mailing Address - Country:US
Mailing Address - Phone:859-263-3900
Mailing Address - Fax:859-263-3757
Practice Address - Street 1:120 N EAGLE CREEK DR
Practice Address - Street 2:STE 500
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1827
Practice Address - Country:US
Practice Address - Phone:859-263-3900
Practice Address - Fax:859-263-3757
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY25118207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64251184Medicaid
WV0095007000Medicaid
OH0678897Medicaid
KY1101602Medicare PIN
KY64251184Medicaid
KYC66126Medicare UPIN