NPIMap

Organization Active NPI

Bluegrass Eye Surgery PSC

  • Ophthalmology Physician
  • Lebanon, KY
National Provider Identifier
1073799268
Registry record updated Nov 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
40650 Issued in KY
Legal business name
BLUEGRASS EYE SURGERY PSC
Practice address
325 W Walnut St
Suite 400
Lebanon, KY 40033-1377
Phone
(270) 692-0047
Fax
(270) 692-0219
NPI assigned
Jan 17, 2008
Last updated
Nov 2, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2010

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

Authorized official

Name
Gary N Wortz, MD
Title
Owner
Phone
(270) 692-0047

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 40650 KY Primary

Addresses

Primary practice location

325 W Walnut St
Suite 400
Lebanon, KY 40033-1377

Mailing address

325 W Walnut St
Suite 400
Lebanon, KY 40033-1377
Phone (270) 692-0047

Other identifiers 1

IdentifierTypeStateIssuer
000000571982OtherKYANTHEM

National Provider Directory

National Provider Directory

Locations

104 Smoky Way
Danville, KY 40422
Phone (270) 692-0047

420 N Loretto Rd
Ste 100
Lebanon, KY 40033
Phone (270) 692-0047

Practitioners & affiliated clinicians

Practitioners 10

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": "1200528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288656000000",
    "number": "1073799268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 W WALNUT ST",
            "address_2": "SUITE 400",
            "city": "LEBANON",
            "state": "KY",
            "postal_code": "400331377",
            "telephone_number": "270-692-0047",
            "fax_number": "270-692-0219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 W WALNUT ST",
            "address_2": "SUITE 400",
            "city": "LEBANON",
            "state": "KY",
            "postal_code": "400331377",
            "telephone_number": "270-692-0047",
            "fax_number": "270-692-0219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEGRASS EYE SURGERY PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-17",
        "last_updated": "2010-11-02",
        "status": "A",
        "authorized_official_last_name": "WORTZ",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-692-0047",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "KY",
            "license": "40650",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000571982",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2010; 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.