Individual
CAROL DEITZ-BERTKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
581 DUDLEY PIKE, EDGEWOOD, KY 41017-3296
(859) 341-0888
(859) 341-3386
Mailing address
2486 LEGENDS WAY, CRESTVIEW HILLS, KY 41017-3479
(859) 341-0888
(859) 341-3386
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1134DT
KY
152WV0400X
Vision Therapy Optometrist
1134DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000049502
BLUE CROSS &BLUE SHIELD
KY
Enumeration date
10/19/2005
Last updated
06/29/2009
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