Organization
BLUEGRASS EYE SURGERY PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY N WORTZ MD (OWNER)
(270) 692-0047
Entity
Organization
Contact information
Practice address
325 W WALNUT ST, SUITE 400, LEBANON, KY 40033-1377
(270) 692-0047
(270) 692-0219
Mailing address
325 W WALNUT ST, SUITE 400, LEBANON, KY 40033-1377
(270) 692-0047
(270) 692-0219
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
40650
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000571982
ANTHEM
KY
Enumeration date
01/17/2008
Last updated
11/02/2010
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