# MEDICAL VISION GROUP, PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003941923
- **Authorized official:** DR. JITANDER S DUDEE M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (859) 278-9486

## Contact information

- **Practice address:** 2459 NICHOLASVILLE RD, LEXINGTON, KY 40503-3158
- **Practice address phone:** (859) 278-9486
- **Practice address fax:** (888) 500-3329
- **Mailing address:** 2459 NICHOLASVILLE RD, LEXINGTON, KY 40503-3158
- **Mailing address phone:** (859) 278-9486
- **Mailing address fax:** (888) 500-3329

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | 30460 | KY | Yes |

## Other

- **Enumeration date:** 02/22/2007
- **Last updated:** 03/23/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 64304603 | — | KY |