| NPI | 1285639666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK M PRUSSIAN Administrator 502-589-1500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 31573) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 28804) |
| 207W00000X Ophthalmology (Licence: KY 28590) | |
| 207W00000X Ophthalmology (Licence: IN 01043769) | |
| 207W00000X Ophthalmology (Licence: IN 01043733) | |
| 207W00000X Ophthalmology (Licence: IN 01040010) | |
| 152W00000X Optometrist (Licence: KY 1136DT) | |
| 152W00000X Optometrist (Licence: KY 1614DT) | |
| 152W00000X Optometrist (Licence: KY 1613DT) | |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2018-10-15 |