Provider Demographics
NPI:1316084403
Name:PARTAIN, JEFFREY LYNN (OD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LYNN
Last Name:PARTAIN
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 1:6400 DUTCHMANS PKWY STE 125
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3342
Mailing Address - Country:US
Mailing Address - Phone:502-896-8700
Mailing Address - Fax:502-896-0813
Practice Address - Street 1:189 ADAM SHEPHERD PKWY STE 20
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6579
Practice Address - Country:US
Practice Address - Phone:502-896-8700
Practice Address - Fax:502-896-0813
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1040DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77010403Medicaid