1750444212 NPI number — DR. JULIE A HERRON O.D.

Table of content: DR. JULIE A HERRON O.D. (NPI 1750444212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750444212 NPI number — DR. JULIE A HERRON O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERRON
Provider First Name:
JULIE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STENGER
Provider Other First Name:
JULIE
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750444212
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2408 LOST WILLOW CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEBRON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41048-7393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-384-2761
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6711 ALEXANDRIA PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41001-1025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-635-0948
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/18/2006

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:  1491DT , 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: 77000172 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000274452 . This is a "ANTHEM PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 49287 . This is a "DAVIS ID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: K1491E . This is a "HUMANA ID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 24453 . This is a "SPECTERA ID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 22-02615 . This is a "UNITED HEALTHCARE ID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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