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Individual

JENNIFER MERCADO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
2174 DIXIE HWY, FORT MITCHELL, KY 41017-2902
(859) 341-2566
(859) 341-2568
Mailing address
2174 DIXIE HWY, FORT MITCHELL, KY 41017-2972
(859) 341-2566

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1653DT
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000372897
ANTHEM
01
61-1169814
TAX IDENTIFICATION
KY
05
7100172260
KY
05
77001659
KY
Enumeration date
08/30/2006
Last updated
12/09/2011
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