Organization
RETINA ASSOCIATES, PSC
Active
Other names
Audubon Optical Shop
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK M PRUSSIAN (ADMINISTRATOR)
(502) 589-1500
Entity
Organization
Contact information
Practice address
2355 POPLAR LEVEL RD, LOUISVILLE, KY 40217-1395
(502) 637-3036
(502) 637-1105
Mailing address
2355 POPLAR LEVEL RD, LOUISVILLE, KY 40217-1395
(502) 637-3036
(502) 637-1105
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100221560
—
IN
05
—
65917502
—
KY
Enumeration date
01/19/2007
Last updated
06/29/2009
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