Provider Demographics
NPI:1992886675
Name:MAYO, ANTHONY J (OD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:MAYO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1625
Mailing Address - Country:US
Mailing Address - Phone:606-784-5355
Mailing Address - Fax:606-784-4864
Practice Address - Street 1:129 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1625
Practice Address - Country:US
Practice Address - Phone:606-784-5355
Practice Address - Fax:606-784-4864
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1114DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000049329OtherANTHEM
KY1924OtherBLUEGRASS
KY611169861OtherHUMANA
KY000000002791OtherCNA
KY77011146Medicaid
KY611169861OtherHUMANA
KYT32944Medicare UPIN
KY1924OtherBLUEGRASS