Healthcare Provider Details

I. General information

NPI: 1396125589
Provider Name (Legal Business Name): STEPHAN GEORGE DIXON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 RAPID RUN RD STE 2
CINCINNATI OH
45238-4260
US

IV. Provider business mailing address

2865 CHANCELLOR DR STE 215
CRESTVIEW HILLS KY
41017-3931
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-5700
  • Fax:
Mailing address:
  • Phone: 859-344-2079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number57.025881
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number57.025881
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: