Individual
DR. RENEE S MCENTIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1536 STORY AVE, LOUISVILLE, KY 40206-1738
(502) 589-1500
(502) 589-1556
Mailing address
1536 STORY AVE, LOUISVILLE, KY 40206-1738
(502) 589-1500
(502) 589-1556
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1678DT
KY
152W00000X
Optometrist
Primary
18003404A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000531030
ANTHEM BCBS
KY
01
—
1678DT
OD LICENSE NUMBER
KY
01
—
18003404A
OD LICENSE NUMBER
IN
05
—
200854690
—
IN
05
—
7100025620
—
KY
Enumeration date
07/05/2006
Last updated
04/14/2025
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