Provider Demographics
NPI:1174593701
Name:TAYLOR, PAUL G (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:G
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-1428
Mailing Address - Country:US
Mailing Address - Phone:270-692-1871
Mailing Address - Fax:270-692-6785
Practice Address - Street 1:310 W HIGH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1428
Practice Address - Country:US
Practice Address - Phone:270-692-1871
Practice Address - Fax:270-692-6785
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1426DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77014264Medicaid
KY0565203Medicare ID - Type Unspecified
KY1278880002Medicare NSC
KY77014264Medicaid