Healthcare Provider Details

I. General information

NPI: 1053659839
Provider Name (Legal Business Name): TRI-STATE CENTERS FOR SIGHT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7527 STATE RD
CINCINNATI OH
45255-6407
US

IV. Provider business mailing address

2865 CHANCELLOR DR SUITE 215
CRESTVIEW HILLS KY
41017-3912
US

V. Phone/Fax

Practice location:
  • Phone: 513-381-1900
  • Fax: 513-287-6403
Mailing address:
  • Phone: 859-581-7120
  • Fax: 859-581-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL A NORDLOH
Title or Position: CEO
Credential:
Phone: 859-344-2061