Individual
AMANDA M BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
325 W WALNUT ST, STE400, LEBANON, KY 40033-1377
(502) 955-2020
(502) 736-4490
Mailing address
5855 RELIABLE PKWY, CHICAGO, IL 60686-0001
(502) 955-2020
(502) 736-4490
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1792DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100110940
—
KY
Enumeration date
10/12/2009
Last updated
06/14/2010
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