Healthcare Provider Details

I. General information

NPI: 1477091080
Provider Name (Legal Business Name): WING EYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 BUTTERMILK PIKE SUITE 100
CRESCENT SPRINGS KY
41017-1318
US

IV. Provider business mailing address

2920 GLENDALE MILFORD RD SUITE 220
CINCINNATI OH
45241-3131
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-3937
  • Fax: 859-341-3940
Mailing address:
  • Phone: 513-922-9000
  • Fax: 513-922-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: STACY BORCHERS
Title or Position: INSURANCE MANAGER
Credential:
Phone: 513-922-9000