Healthcare Provider Details

I. General information

NPI: 1801379797
Provider Name (Legal Business Name): TRI-STATE CENTERS FOR SIGHT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 10/03/2018
Certification Date:
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

PO BOX 631662
CINCINNATI OH
45263-1662
US

V. Phone/Fax

Practice location:
  • Phone: 859-581-7120
  • Fax: 859-581-7207
Mailing address:
  • Phone: 859-344-2079
  • Fax: 859-581-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY W KEMPER
Title or Position: CREDENTIALS
Credential:
Phone: 859-344-2079