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General NPI Number Information
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NPI Number | 1477950269
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Entity Type | Organization
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Legal Business Name | TRI-STATE CENTERS FOR SIGHT, INC
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 11/26/2014
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Provider Practice Location Address
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Address Line | 802 SCOTT ST
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City | COVINGTON
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State | KY
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Zip | 41011-2420
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Country | US
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Telephone | 859-341-4525
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Fax | 859-341-4993
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Provider Business Mailing Address
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Address Line | 2865 CHANCELLOR DR SUITE 215
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City | CRESTVIEW HILLS
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State | KY
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Zip | 41017-3912
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Country | US
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Telephone | 859-344-2079
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Fax | 859-581-7207
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Authorized Official
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Title or Position | CEO
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Name | DANIEL A NORDLOH
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Credential |
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Telephone | 859-344-2061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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