Healthcare Provider Details

I. General information

NPI: 1437191764
Provider Name (Legal Business Name): KEVIN MICHAEL PREZGAY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

486 OHIO PIKE
CINCINNATI OH
45255
US

IV. Provider business mailing address

1630 FAIRWAY CRST
LOVELAND OH
45140-5810
US

V. Phone/Fax

Practice location:
  • Phone: 513-753-8225
  • Fax: 513-753-8589
Mailing address:
  • Phone: 513-697-1717
  • Fax: 513-697-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOH5146
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: