Provider Demographics
NPI:1962793976
Name:KSM, PLLC
Entity type:Organization
Organization Name:KSM, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:SANTOS
Authorized Official - Last Name:MCCLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-327-3701
Mailing Address - Street 1:2716 OLD ROSEBUD RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8008
Mailing Address - Country:US
Mailing Address - Phone:859-327-3701
Mailing Address - Fax:
Practice Address - Street 1:2716 OLD ROSEBUD RD
Practice Address - Street 2:SUITE 130
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8008
Practice Address - Country:US
Practice Address - Phone:859-327-3701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty