Healthcare Provider Details

I. General information

NPI: 1235226085
Provider Name (Legal Business Name): ELLIOT MARC KIRSTEIN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8211 CORNELL ROAD SUITE 510
CINCINNATI OH
45249-2235
US

IV. Provider business mailing address

8211 CORNELL RD SUITE 510
CINCINNATI OH
45249-2235
US

V. Phone/Fax

Practice location:
  • Phone: 513-530-0440
  • Fax: 513-530-0473
Mailing address:
  • Phone: 513-530-0440
  • Fax: 513-530-0473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3248-T514
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3248
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: