NPIMap

Organization Active NPI

Ky Doctors of Optometry, PLLC

  • Eyewear Supplier
  • Louisville, KY
National Provider Identifier
1205919099
Registry record updated Aug 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
KY DOCTORS OF OPTOMETRY, PLLC
Practice address
1001 Breckinridge Lane
Louisville, KY 40207
Phone
(502) 893-2015
Fax
(502) 451-2934
NPI assigned
Oct 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2024

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

Authorized official

Name
Grant Rubesh, O.D.
Title
Owner
Phone
(726) 444-4078

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

1001 Breckinridge Lane
Louisville, KY 40207

Mailing address

PO Box 846027
Dallas, TX 75284-6027
Phone (210) 524-6663

Other identifiers 2

IdentifierTypeStateIssuer
7790297100MedicaidKY
100470960FMedicaidIN

Other names 2

  • KY Doctors of Optometry Doing business as
  • Visionworks Doctors of Optometry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930028030 KY DME Supplier - Physician - Optometrist 0941108732 Practice locations: Louisville, KY

Other NPIs with the same Medicare PAC ID 22

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 22

National Provider Directory

National Provider Directory
Tax ID family
Dr Mark Lynn and Associat22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Locations

5047 Shelbyville Rd
St Matthews, KY 40207
Phone (502) 293-5340

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724284800000",
    "number": "1205919099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 846027",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752846027",
            "telephone_number": "210-524-6663",
            "fax_number": "210-524-6587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 BRECKINRIDGE LANE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40207",
            "telephone_number": "502-893-2015",
            "fax_number": "502-451-2934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KY DOCTORS OF OPTOMETRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2024-08-22",
        "certification_date": "2024-08-22",
        "status": "A",
        "authorized_official_last_name": "RUBESH",
        "authorized_official_first_name": "GRANT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "726-444-4078",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7790297100",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100470960F",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KY Doctors of Optometry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Visionworks Doctors of Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.