Healthcare Provider Details

I. General information

NPI: 1669879151
Provider Name (Legal Business Name): TRI-STATE CENTERS FOR SIGHT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4452 EASTGATE BLVD SUITE 305
CINCINNATI OH
45245-1584
US

IV. Provider business mailing address

2865 CHANCELLOR DR SUITE 215
CRESTVIEW HILLS KY
41017-3912
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 Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: JACKIE C BARBERY
Title or Position: ADMINISTRATOR
Credential:
Phone: 859-344-2062