Healthcare Provider Details

I. General information

NPI: 1114095213
Provider Name (Legal Business Name): TRI-STATE CENTERS FOR SIGHT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 02/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 W 7TH ST
COVINGTON KY
41011-2301
US

IV. Provider business mailing address

PO BOX 631662
CINCINNATI OH
45263-1662
US

V. Phone/Fax

Practice location:
  • Phone: 859-581-2212
  • Fax: 859-581-4337
Mailing address:
  • Phone: 859-581-7120
  • Fax: 859-581-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL A NORDLOH
Title or Position: ADMINISTRATOR
Credential:
Phone: 859-581-7120