| NPI | 1417592536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY AMMON Manager 502-244-2440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 231H00000X Audiologist |
| 363L00000X Nurse Practitioner | |
| 152W00000X Optometrist | |
| 213E00000X Podiatrist | |
| Enumeration Date | 2019-11-12 |
| Last Update Date | 2020-02-05 |