Provider Demographics
NPI:1528065612
Name:BADILLO, AIDA I (OD)
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:I
Last Name:BADILLO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0001
Mailing Address - Country:US
Mailing Address - Phone:502-955-2020
Mailing Address - Fax:502-736-4490
Practice Address - Street 1:7900 SHELBYVILLE RD STE A15
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5463
Practice Address - Country:US
Practice Address - Phone:502-327-8568
Practice Address - Fax:502-327-0613
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003026152W00000X
KY1471DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77000305Medicaid
IN200312800Medicaid
IN5375220001Medicare NSC
IN226010AMedicare PIN
KY5375220003Medicare NSC
KYK193580Medicare PIN
KY77000305Medicaid
KYU82196Medicare UPIN