Provider Demographics
NPI:1053347310
Name:DR. SASHA RADFORD, LLC
Entity type:Organization
Organization Name:DR. SASHA RADFORD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-872-9522
Mailing Address - Street 1:313 NICHOLAS RIDGE DR
Mailing Address - Street 2:SUITE E-7
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-4201
Mailing Address - Country:US
Mailing Address - Phone:270-872-9522
Mailing Address - Fax:
Practice Address - Street 1:313 NICHOLAS RIDGE DR
Practice Address - Street 2:SUITE E-7
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-4201
Practice Address - Country:US
Practice Address - Phone:270-872-9522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1573DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYV04251Medicare UPIN