Provider Demographics
NPI:1144280678
Name:METZGER AUBUCHON, JULIE A (OD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:METZGER AUBUCHON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:METZGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:6901 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2007
Mailing Address - Country:US
Mailing Address - Phone:859-525-1800
Mailing Address - Fax:859-525-1951
Practice Address - Street 1:6901 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2007
Practice Address - Country:US
Practice Address - Phone:859-525-1800
Practice Address - Fax:859-525-1951
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1271DT152W00000X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45775772Medicaid
KY77012714Medicaid
KYU46802Medicare UPIN
KY45775772Medicaid