MEDICARE: CINCINNATI EYE CARE TEAM LLC

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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1760412464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CINCINNATI EYE CARE TEAM LLC

Provider Business Mailing Address
First Line	:	8629 N PAVILION DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-4885
Country	:	US
Telephone Number	:	513-860-0400
Fax Number	:	513-942-5321

Provider Business Practice Location Address
First Line	:	8629 N PAVILION DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-4885
Country	:	US
Telephone Number	:	513-860-0400
Fax Number	:	513-942-5321

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DIANA WATKINS GILBERT
Credential	:	O.D.
Telephone Number	:	513-860-0400

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	02/20/2009

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