MEDICARE: TRISTATE CENTERS FOR SIGHT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255408860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRISTATE CENTERS FOR SIGHT, INC.

Provider Business Mailing Address
First Line	:	2865 CHANCELLOR DR STE 215
Second Line	:
City	:	CRESTVIEW HILLS
State	:	KY
Zip	:	41017-3931
Country	:	US
Telephone Number	:	859-331-1058
Fax Number	:	513-791-4567

Provider Business Practice Location Address
First Line	:	2055 READING RD
Second Line	:	SUITE 330
City	:	CINCINNATI
State	:	OH
Zip	:	45202-1461
Country	:	US
Telephone Number	:	513-381-1900
Fax Number	:	513-287-6403

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DANIEL A NORDLOH
Credential	:
Telephone Number	:	859-581-7120

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	05/20/2024

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Directions to “TRISTATE CENTERS FOR SIGHT, INC. ” Practice Location

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