Provider Demographics
NPI:1285760926
Name:MIDDLETOWN EYE CARE PLLC
Entity type:Organization
Organization Name:MIDDLETOWN EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-245-9568
Mailing Address - Street 1:13324 SHELBYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3936
Mailing Address - Country:US
Mailing Address - Phone:502-245-9568
Mailing Address - Fax:502-254-1425
Practice Address - Street 1:13324 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3936
Practice Address - Country:US
Practice Address - Phone:502-245-9568
Practice Address - Fax:502-254-1425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25403332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5133090001Medicare ID - Type Unspecified