Provider Demographics
NPI:1962087429
Name:PDS CONSULTANTS OPTICAL LLC
Entity type:Organization
Organization Name:PDS CONSULTANTS OPTICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-897-1656
Mailing Address - Street 1:4036 DUTCHMANS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4704
Mailing Address - Country:US
Mailing Address - Phone:502-895-2020
Mailing Address - Fax:
Practice Address - Street 1:4917 DIXIE HWY STE H
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-2565
Practice Address - Country:US
Practice Address - Phone:502-447-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PDS CONSULTANTS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-16
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty