Organization
SHOUSE OPTICAL SERVICE, INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN WILL SHOUSE OPTICIAN (PRESIDENT)
(859) 276-1594
Entity
Organization
Contact information
Practice address
101 MALABU DR, SUITE #7, LEXINGTON, KY 40503-3141
(859) 276-1594
(859) 277-6421
Mailing address
101 MALABU DR, SUITE #7, LEXINGTON, KY 40503-3141
(859) 276-1594
(859) 277-6421
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000073323
ANTHEM BCBS
KY
05
—
52902384
—
KY
Enumeration date
04/17/2007
Last updated
07/21/2022
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