Organization
CAROL LYNN DEITZ O D INC
Active
Other names
Edgewood Eye Center
Organization subpart
No
Provider details
NPI number
Authorized official
SHEILA J KING (MANAGER/OPTICIAN)
(859) 341-0888
Entity
Organization
Contact information
Practice address
581 DUDLEY RD., EDGEWOOD, KY 41017-3296
(859) 341-0888
(859) 341-3386
Mailing address
581 DUDLEY RD., EDGEWOOD, KY 41017-3296
(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
03/11/2008
Last updated
06/28/2016
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