Provider Demographics
NPI:1215906110
Name:CALLIHAN, REGINA (OD)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:
Last Name:CALLIHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CROSSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1444
Mailing Address - Country:US
Mailing Address - Phone:859-879-3665
Mailing Address - Fax:
Practice Address - Street 1:105 CROSSFIELD DR
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1444
Practice Address - Country:US
Practice Address - Phone:859-879-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1593-DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77001287Medicaid
KY1101640Medicare PIN
KY77001287Medicaid
KY0932902Medicare ID - Type Unspecified