Provider Demographics
NPI:1174909014
Name:KAILEY, MANAVJEET (OD)
Entity type:Individual
Prefix:
First Name:MANAVJEET
Middle Name:
Last Name:KAILEY
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 1:3801 SPRINGHURST BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6137
Mailing Address - Country:US
Mailing Address - Phone:502-423-4444
Mailing Address - Fax:
Practice Address - Street 1:3801 SPRINGHURST BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-6137
Practice Address - Country:US
Practice Address - Phone:502-423-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2002DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist