Organization
EYE SURGERY OF KENTUCKIANNA LLLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMMED ALI HAIDER (MEDICAL DIRECTOR)
(502) 883-1015
Entity
Organization
Contact information
Practice address
2932 BRECKENRIDGE LN STE 5, LOUISVILLE, KY 40220-1490
(502) 883-1015
Mailing address
2932 BRECKENRIDGE LN STE 5, LOUISVILLE, KY 40220-1490
(502) 883-1015
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
261QS0132X
Ophthalmologic Surgery Clinic/Center
—
—
Other
Enumeration date
08/18/2021
Last updated
08/18/2021
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