Provider Demographics
NPI:1194561845
Name:PLUMLEY, JACOB VAUGHAN (OD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:VAUGHAN
Last Name:PLUMLEY
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 1:1864 KY ROUTE 302
Mailing Address - Street 2:
Mailing Address - City:VAN LEAR
Mailing Address - State:KY
Mailing Address - Zip Code:41265-9059
Mailing Address - Country:US
Mailing Address - Phone:606-385-0007
Mailing Address - Fax:
Practice Address - Street 1:3695 NICHOLASVILLE RD STE 150
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-4493
Practice Address - Country:US
Practice Address - Phone:859-273-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2403DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist