1184605685 NPI number — DR. MOLLY WEST DOERR OD

Table of content: DR. MOLLY WEST DOERR OD (NPI 1184605685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184605685 NPI number — DR. MOLLY WEST DOERR OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOERR
Provider First Name:
MOLLY
Provider Middle Name:
WEST
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEST DOERR
Provider Other First Name:
MOLLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1184605685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 OLD LEBANON RD.
Provider Second Line Business Mailing Address:
EYE INSTITUTE OF KENTUCKY
Provider Business Mailing Address City Name:
CAMPBELLSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-789-2023
Provider Business Mailing Address Fax Number:
270-465-5361

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 OLD LEBANON RD.
Provider Second Line Business Practice Location Address:
EYE INSTITUTE OF KENTUCKY
Provider Business Practice Location Address City Name:
CAMPBELLSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-789-2023
Provider Business Practice Location Address Fax Number:
270-465-5361
Provider Enumeration Date:
11/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0872DT , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X , with the licence number: 872DT , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0178520001 . This is a "PALMETTO GBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32055 . This is a "DAVIS VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611139709 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611139709 . This is a "MED BEN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 911199 . This is a "BLOCK VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: MD17067 . This is a "SPECTERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00000000049084 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410012251 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: VF19372 . This is a "VISION CARE ADVANTAGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15300 . This is a "ALTERNATIVE HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611139709 . This is a "VISION CARE PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 77008720 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 375807 . This is a "CLARITY VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5025326332 . This is a "VISION SERVICE PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45001526 . This is a "EPSDT MEDICAID KY" identifier . This identifiers is of the category "OTHER".
  • Identifier: KY0872 . This is a "EYE MED VISION CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4643655 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611139709A . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".




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