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Ky Doctors of Optometry, PLLC

Organization Active NPI Eyewear Supplier · Paducah, KY

NPI 1477637726 · NPPES record last updated Oct 14, 2024

Key facts

NPI
1477637726
Entity type
Organization (NPI type 2)
Primary specialty
Eyewear Supplier 332H00000X
Legal business name
KY DOCTORS OF OPTOMETRY, PLLC
Practice address
3910 Hinkleville Road
Paducah, KY 42001
Phone
(270) 443-2090
Fax
(270) 444-2086
NPI assigned
Oct 24, 2006
Organization subpart
No

Authorized official

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

Other NPIs with the same Medicare PAC ID 22

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

Corporate family (same tax ID) 21

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

Practitioners 64

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

View all 64

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Ky Doctors of Optometry, PLLC
3910 Hinkleville Rd, Paducah, KY 42001-9017 · (270) 443-2090		 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignment
Participating since Oct 1, 1998

Medicare participation

Medicare fee-for-service enrollment
Enrolled in KY

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100930003002 KY DME Supplier - Physician - Optometrist
DME Supplier - Optician		 0941108732 Practice locations: Paducah, KY

National Provider Directory

Tax ID family
Dr Mark Lynn and Associat (22 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Yes

Addresses

Primary practice location

3910 Hinkleville Road
Paducah, KY 42001

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
7790300300MedicaidKY

Other names

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

Other providers in Paducah, KY

All providers in Paducah, KY · Eyewear Supplier in Kentucky

Sources for this page

Verify at the official NPI Registry.