Provider Demographics
NPI:1518798255
Name:WAY MAKER KY LLC
Entity type:Organization
Organization Name:WAY MAKER KY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN-MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-271-2859
Mailing Address - Street 1:823 DAHL ELROD ROAD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501
Mailing Address - Country:US
Mailing Address - Phone:606-271-2859
Mailing Address - Fax:
Practice Address - Street 1:100 WALTON AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-8414
Practice Address - Country:US
Practice Address - Phone:859-236-9866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty