Provider Demographics
NPI:1801894340
Name:BIRGE, STEVEN K (OD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:K
Last Name:BIRGE
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 1:22 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:TOMPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42167-7478
Mailing Address - Country:US
Mailing Address - Phone:270-487-5741
Mailing Address - Fax:270-487-9664
Practice Address - Street 1:22 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167-7478
Practice Address - Country:US
Practice Address - Phone:270-487-5741
Practice Address - Fax:270-487-9664
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1101DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000199522OtherBCBS
03322OtherSPECTERA
KY1386776169OtherMEDICARE GROUP
KY1386776169Medicaid
KY8846OtherMEDICARE P-10
410049286OtherRR MEDICARE
KY77011013Medicaid
KY1801894340Medicaid
5940OtherDAVIS VISION
4385920001Medicare NSC