Healthcare Provider Details

I. General information

NPI: 1699872887
Provider Name (Legal Business Name): SHARONVILLE EVENDALE EYECARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10675 MCSWAIN DR
CINCINNATI OH
45241-3168
US

IV. Provider business mailing address

10675 MCSWAIN DR
CINCINNATI OH
45241-3168
US

V. Phone/Fax

Practice location:
  • Phone: 513-536-2304
  • Fax: 513-563-2356
Mailing address:
  • Phone: 513-536-2304
  • Fax: 513-563-2356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4672/T1447
License Number StateOH

VIII. Authorized Official

Name: BRENDA S. MURRAY
Title or Position: PRESIDENT/OWNER
Credential: O.D.
Phone: 513-563-2304