Healthcare Provider Details

I. General information

NPI: 1992004931
Provider Name (Legal Business Name): TRI-STATE CENTERS FOR SIGHT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8044 MONTGOMERY RD SUITE 155
CINCINNATI OH
45236-2919
US

IV. Provider business mailing address

802 SCOTT ST SUITE 201
COVINGTON KY
41011-2420
US

V. Phone/Fax

Practice location:
  • Phone: 513-936-3734
  • Fax: 513-791-1473
Mailing address:
  • Phone: 859-581-7120
  • Fax: 859-581-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL A NORDLOH
Title or Position: ADMINISTRATOR
Credential:
Phone: 859-581-7120