Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1397DT | KY |
NPI | 1003880212 |
---|---|
Provider Name | Laura Lea Bassett |
First Address | Louisville, KY 40222-5409 |
Second Address | Louisville, KY 40222-5409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 20/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
76107 | (02) | |
P00850450 | RR MEDICARE (01) |