Healthcare Provider Details

I. General information

NPI: 1477950269
Provider Name (Legal Business Name): TRI-STATE CENTERS FOR SIGHT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 SCOTT ST
COVINGTON KY
41011-2420
US

IV. Provider business mailing address

2865 CHANCELLOR DR SUITE 215
CRESTVIEW HILLS KY
41017-3912
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-4525
  • Fax: 859-341-4993
Mailing address:
  • Phone: 859-344-2079
  • 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: CEO
Credential:
Phone: 859-344-2061