Provider Demographics
NPI:1487697298
Name:MAX M DOWNEY OD PSC
Entity type:Organization
Organization Name:MAX M DOWNEY OD PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-384-6043
Mailing Address - Street 1:1463 CAMPBELLSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-2263
Mailing Address - Country:US
Mailing Address - Phone:270-384-6043
Mailing Address - Fax:270-384-0672
Practice Address - Street 1:1463 CAMPBELLSVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-2263
Practice Address - Country:US
Practice Address - Phone:270-384-6043
Practice Address - Fax:270-384-0672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77009793Medicaid
KY77904126Medicaid
KY9801Medicare ID - Type UnspecifiedGROUP