Provider Demographics
NPI:1306578554
Name:POPE, FOREST TYLER (OD)
Entity type:Individual
Prefix:
First Name:FOREST
Middle Name:TYLER
Last Name:POPE
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 1:4070 VICTORIA WAY APT 23
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-4691
Mailing Address - Country:US
Mailing Address - Phone:859-797-3643
Mailing Address - Fax:
Practice Address - Street 1:150 W LOWRY LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3020
Practice Address - Country:US
Practice Address - Phone:859-436-6632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2283DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist