Airneida Bumgardner-Miles
Individual provider Active NPI Optician · Oak Grove, KY
NPI 1639879455 · NPPES record last updated Mar 9, 2023
Key facts
- NPI
- 1639879455
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optician 156FX1800X
- License
- 111731 (KY)
- Practice address
- 14800 Fort Campbell Blvd
Oak Grove, KY 42262-8304 - Phone
- (270) 640-4828
- NPI assigned
- Mar 9, 2023
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111731 | KY | MD | Optician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 111731 | KY | Yes |
Addresses
Primary practice location
14800 Fort Campbell Blvd
Oak Grove, KY 42262-8304
Mailing address
14800 Fort Campbell Blvd
Oak Grove, KY 42262-8304
Phone (270) 640-4828
Other providers in Oak Grove, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.