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NPI Code Detail

MEDICARE: RED BANK EYE ASSOCIATE, LLC

MEDICARE: RED BANK EYE ASSOCIATE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist4165OH

General Provider Information

NPI Number : 1790089837
Entity Type Code : Organization
Provider Name (Legal Business Name) : RED BANK EYE ASSOCIATE, LLC
Provider Business Mailing Address
First Line : 4060 WATERFORD WAY
Second Line :
City : CINCINNATI
State : OH
Zip : 45245-1956
Country : US
Telephone Number : 513-753-0953
Fax Number :
Provider Business Practice Location Address
First Line : 4000 RED BANK RD
Second Line : @WAL-MART VISION CENTER
City : CINCINNATI
State : OH
Zip : 45227-3416
Country : US
Telephone Number : 513-351-9768
Fax Number : 513-351-9809
Authorized Official
Title or Position : PRESIDENT
Name : DR. MICHAEL THOMAS POWERS
Credential : O.D.
Telephone Number : 513-351-9768
Provider Enumeration Date : 01/04/2011
Last Update Date : 01/04/2011

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Directions to “RED BANK EYE ASSOCIATE, LLC ” Practice Location

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