NPIMap

Organization Active NPI

Bluegrass Eyecare Center, PLLC

  • Ophthalmology Physician
  • Lexington, KY
National Provider Identifier
1063680304
Registry record updated Sep 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
21381 Issued in KY
Legal business name
BLUEGRASS EYECARE CENTER, PLLC
Practice address
715 Shaker Dr
Suite 120
Lexington, KY 40504-3674
Phone
(859) 278-8443
NPI assigned
Feb 20, 2008
Last updated
Sep 8, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. W Douglas Back, M.D.NPI 1396765251
Title
Secretary/Member
Phone
(859) 278-8443

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X 21381 KY Primary

Addresses

Primary practice location

715 Shaker Dr
Suite 120
Lexington, KY 40504-3674

Mailing address

715 Shaker Dr
Suite 120
Lexington, KY 40504-3674
Phone (859) 278-8443

Other identifiers 2

IdentifierTypeStateIssuer
00599OtherMEDICARE GROUP NUMBER
7100030920MedicaidKY

National Provider Directory

National Provider Directory

Locations

715 Shaker Dr
Ste 120
Lexington, KY 40504
Phone (859) 278-8443

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220832000000",
    "number": "1063680304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 SHAKER DR",
            "address_2": "SUITE 120",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405043674",
            "telephone_number": "859-278-8443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 SHAKER DR",
            "address_2": "SUITE 120",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405043674",
            "telephone_number": "859-278-8443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEGRASS EYECARE CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-20",
        "last_updated": "2008-09-08",
        "status": "A",
        "authorized_official_last_name": "BACK",
        "authorized_official_first_name": "W DOUGLAS",
        "authorized_official_title_or_position": "SECRETARY/MEMBER",
        "authorized_official_telephone_number": "859-278-8443",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "KY",
            "license": "21381",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "00599",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100030920",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.