Provider Demographics
NPI:1386705739
Name:BYRD, J. A (OD)
Entity type:Individual
Prefix:DR
First Name:J.
Middle Name:A
Last Name:BYRD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6434 N PRESTON HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-4488
Mailing Address - Country:US
Mailing Address - Phone:502-957-2149
Mailing Address - Fax:502-957-4738
Practice Address - Street 1:6434 N PRESTON HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-4488
Practice Address - Country:US
Practice Address - Phone:502-957-2149
Practice Address - Fax:502-957-4738
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0810DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77008100Medicaid
KY610915657OtherTAX ID
KY911201OtherPASSPORT
KY9177301Medicare ID - Type Unspecified
KY77008100Medicaid
KY0652820001Medicare NSC