Healthcare Provider Details

I. General information

NPI: 1548312093
Provider Name (Legal Business Name): EYE - TECH OPT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2057 BEECHMONT AVE
CINCINNATI OH
45230
US

IV. Provider business mailing address

645 WALNUT ST
CINCINNATI OH
45202
US

V. Phone/Fax

Practice location:
  • Phone: 513-233-3937
  • Fax:
Mailing address:
  • Phone: 513-421-2911
  • Fax: 513-421-4416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberSC4729
License Number StateOH

VIII. Authorized Official

Name: MRS. JOANN DESALVO STONE
Title or Position: PART OWNER
Credential: OPTICIAN DO
Phone: 513-421-2911