Provider Demographics
NPI:1699117549
Name:KERNS, LAURA STEFFEN (OD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:STEFFEN
Last Name:KERNS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:MARILYN
Other - Last Name:STEFFEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:9474 BROWNSBORO RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-1118
Mailing Address - Country:US
Mailing Address - Phone:502-882-1442
Mailing Address - Fax:859-236-0523
Practice Address - Street 1:9474 BROWNSBORO RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-1118
Practice Address - Country:US
Practice Address - Phone:502-882-1442
Practice Address - Fax:502-384-0574
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1932DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100260850Medicaid
KYK114600Medicare PIN