=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053300517
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CEI PHYSICIANS PSC, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2005
-----------------------------------------------------
Last Update Date | 10/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1945 CEI DR
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45242-5664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-984-5133
-----------------------------------------------------
Fax | 513-569-3741
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1945 CEI DR
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45242-5664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-984-5133
-----------------------------------------------------
Fax | 513-569-3741
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CORPORATE CREDENTIALS MANAGER
-----------------------------------------------------
Name | MS. TERI J KNIGHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 513-569-3741
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------