Retina Associates, Psc, NPI 1679626139
Optician in Louisville, KY, US

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NPI number: what is it?

The NPI, or National Provider Identifier, is a non-repeatable number for health care providers. The NPI always consists of 10 digits and is used for administrative and financial procedures. The NPI wa...

NPI 1679626139
NPI Entity Type Organization
Provider Name Retina Associates, Psc
Other Name
Enumeration Date September 30, 2009
Last Update Date September 30, 2009
Provider Location Address 2355 Poplar Level Rd, Louisville, KY, US
Provider Mailing Address 2355 Poplar Level Rd, Louisville, KY, US, 402171395
Is Sole Proprietor? No
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Organization Official

Official Name MR. Mark M Prussian
Official Position ADMINISTRATOR
Phone 502-589-1500

Group Taxonomy

Taxonomy Code 193400000X
Taxonomy Name 193400000X MULTIPLE SINGLE SPECIALTY GROUP
Definition A business group of one or more individual practitioners, all of who practice with the same area of specialization.

Primary Taxonomy

Taxonomy Code

156FX1800X

Taxonomy Name Optician
Classification

Technician/Technologist

Group

Eye and Vision Services Providers

Description Definition to come...

Other Organization Name

Audubon Optical Shop
Other Name

Business Address

Retina Associates, Psc
2355 Poplar Level Rd

Louisville, KY, US

Phone: 502-637-3036
Fax: 502-637-1105

Mailing Address

Retina Associates, Psc
2355 Poplar Level Rd
Louisville, KY, US
ZIP 402171395
Phone: 502-637-3036
Fax: 502-637-1105

Other Identifiers

Identifier Identifier State Identifier Issuer Type/Code
100221560 IN MEDICAID 05
65917502 KY MEDICAID 05

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1568107415

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Organization

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M.D. Michael Crum

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PA-C Brittney R. Judhan

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MD Brett E Jarrell

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APRN Danny Brent Newsome

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DO John M Fleming

Individual

Family Medicine Physician

911 Bypass Rd Bldg A

Pikeville, KY

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