Healthcare Provider Details

I. General information

NPI: 1942908884
Provider Name (Legal Business Name): DORIS TEN LICENSED OPTICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 CUNNINGHAM RD
CINCINNATI OH
45241-3270
US

IV. Provider business mailing address

2801 CUNNINGHAM RD
CINCINNATI OH
45241-3270
US

V. Phone/Fax

Practice location:
  • Phone: 513-769-1184
  • Fax: 513-769-1264
Mailing address:
  • Phone: 513-769-1184
  • Fax: 513-769-1264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberOP.004695-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: