Provider Demographics
NPI:1841657947
Name:UNIVERSITY OF PIKEVILLE
Entity type:Organization
Organization Name:UNIVERSITY OF PIKEVILLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DEAN FOR CLINICAL AFFRAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAUDILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-218-5528
Mailing Address - Street 1:147 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-9118
Mailing Address - Country:US
Mailing Address - Phone:606-218-5540
Mailing Address - Fax:606-218-5509
Practice Address - Street 1:147 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501
Practice Address - Country:US
Practice Address - Phone:606-218-5540
Practice Address - Fax:606-218-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1341152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty