Individual
JUSTIN RAY TRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1748 BROADWAY ST, PADUCAH, KY 42001-2706
(270) 443-9955
(270) 442-1469
Mailing address
1748 BROADWAY ST, PADUCAH, KY 42001-2706
(270) 443-9955
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2001-IOD1
WV
152W00000X
Optometrist
Primary
2138DT
KY
Other
Enumeration date
07/20/2013
Last updated
09/03/2019
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