Provider Demographics
NPI:1306979877
Name:KENTUCKY INSTITUTE FOR EYE HEALTH AND SURGERY
Entity type:Organization
Organization Name:KENTUCKY INSTITUTE FOR EYE HEALTH AND SURGERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOODWOTH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:859-278-9393
Mailing Address - Street 1:1401 HARRODSBURG RD
Mailing Address - Street 2:B75
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3751
Mailing Address - Country:US
Mailing Address - Phone:859-278-9393
Mailing Address - Fax:859-277-3965
Practice Address - Street 1:161 CITIZENS LN
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1352
Practice Address - Country:US
Practice Address - Phone:606-436-3313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCA7200Medicare PIN