Individual
BLAKE ISERNHAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
120 N EAGLE CREEK DR, STE 500, LEXINGTON, KY 40509
(859) 263-3900
(859) 263-3757
Mailing address
120 N EAGLE CREEK DR, STE 500, LEXINGTON, KY 40509-1827
(859) 263-3900
(859) 263-3757
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
48761
KY
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
48761
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0163986
—
OH
05
—
1336469444
—
WV
05
—
200312510A
—
OK
05
—
300015774
—
IN
05
—
7100400550
—
KY
Enumeration date
06/11/2010
Last updated
08/22/2018
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