Provider Demographics
NPI:1902587660
Name:BLUEGRASS VISION GROUP OF HAMBURG PLLC
Entity Type:Organization
Organization Name:BLUEGRASS VISION GROUP OF HAMBURG PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-498-4800
Mailing Address - Street 1:2716 OLD ROSEBUD RD STE 130
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8007
Mailing Address - Country:US
Mailing Address - Phone:859-327-3701
Mailing Address - Fax:859-327-3703
Practice Address - Street 1:2716 OLD ROSEBUD RD STE 130
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8007
Practice Address - Country:US
Practice Address - Phone:859-327-3701
Practice Address - Fax:859-327-3703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty