Provider Demographics
NPI:1306900790
Name:NORDIN EYE CENTER, PSC
Entity type:Organization
Organization Name:NORDIN EYE CENTER, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERPRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-788-0433
Mailing Address - Street 1:917 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:917 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1407
Practice Address - Country:US
Practice Address - Phone:606-788-0433
Practice Address - Fax:606-789-5053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11243DT152W00000X
KY1176DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7790274Medicaid
KY77011765Medicaid
KY77012433Medicaid
KY3920Medicare ID - Type UnspecifiedSVILLE GROUP NUMBER
KY7790274Medicaid
KY9392002Medicare ID - Type UnspecifiedDR. MARK NORDIN
KY9392001Medicare ID - Type UnspecifiedDR. KIM NORDIN
KY77012433Medicaid