Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1230-DT | KY |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 1230- DT | KY |
NPI | 1003960634 |
---|---|
Provider Name | Dr. Jeffrey Shane Osborne |
First Address | Pikeville, KY 41501 |
Second Address | Pikeville, KY 41501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 04/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003960634 | (05) | KY |
77012300 | (05) | KY |
U26619 | (02) | |
U26619 | (02) | KY |