Hagedorn, Gregory Brent
Hagedorn, Gregory Brent is an sole proprietor health care provider with primary practice located at 1413 N Elm St Suite 102, Henderson KY 42420-2768. He recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Corneal and Contact Management. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Hagedorn, Gregory Brent can be contacted via phone (270) 826-1500.Contact Information
Primary practice address
1413 N Elm St Suite 102
Henderson KY 42420-2768
Phone: (270) 826-1500
Fax: (270) 827-0757
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 1016DT | Kentucky |
| Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | 1016DT | Kentucky |
Profile Details
| NPI number | 1316905169 |
|---|---|
| LBN Legal business name | Hagedorn, Gregory Brent |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 2nd, 2006 |
| Last updated | Jul 22nd, 2014 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1316905169 | NPPES |
| Kentucky | MEDICAID | 77010163 |
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