Provider Demographics
NPI:1528831542
Name:CENTRAL KENTUCKY FAMILY VISION PLLC
Entity type:Organization
Organization Name:CENTRAL KENTUCKY FAMILY VISION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TANNER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-282-8901
Mailing Address - Street 1:502 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484-1343
Mailing Address - Country:US
Mailing Address - Phone:859-279-1994
Mailing Address - Fax:
Practice Address - Street 1:502 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484-1343
Practice Address - Country:US
Practice Address - Phone:859-279-1994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty