=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649083965
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRI-STATE CENTERS FOR SIGHT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2025
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 341 COURT ST
-----------------------------------------------------
City | PAINTSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41240-1051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-784-3393
-----------------------------------------------------
Fax | 606-784-3763
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 ROSS ST # 154-0455
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15262-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF REVENUE CYCLE OFFICER
-----------------------------------------------------
Name | CANDICE B DAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-990-7590
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------