Healthcare Provider Details

I. General information

NPI: 1467151159
Provider Name (Legal Business Name): TONYA SHENAE BISHOP-GABLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 FERGUSON RD
CINCINNATI OH
45238-3503
US

IV. Provider business mailing address

895 CLINTON SPRINGS AVE APT 2
CINCINNATI OH
45229-1432
US

V. Phone/Fax

Practice location:
  • Phone: 513-922-3278
  • Fax: 513-922-3473
Mailing address:
  • Phone: 513-714-8544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberOP.017319-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: