Healthcare Provider Details

I. General information

NPI: 1316199953
Provider Name (Legal Business Name): ELIZABETH C CORREA O.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH CHRISTINE CORREA OD

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 BLUE ROCK RD
CINCINNATI OH
45239-6332
US

IV. Provider business mailing address

10782 RUSHDEN CT
POWELL OH
43065-7424
US

V. Phone/Fax

Practice location:
  • Phone: 513-741-4000
  • Fax: 513-741-4056
Mailing address:
  • Phone: 614-325-0512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberT2530
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5616
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: