1992004931 NPI number — TRI-STATE CENTERS FOR SIGHT INC

Table of content: (NPI 1992004931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992004931 NPI number — TRI-STATE CENTERS FOR SIGHT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI-STATE CENTERS FOR SIGHT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TRI-STATE CENTERS FOR SIGHT SURGERY CENTER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992004931
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
802 SCOTT ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41011-2420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-581-7120
Provider Business Mailing Address Fax Number:
859-581-7207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8044 MONTGOMERY RD
Provider Second Line Business Practice Location Address:
SUITE 155
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45236-2919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-936-3734
Provider Business Practice Location Address Fax Number:
513-791-1473
Provider Enumeration Date:
03/16/2011

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QS0132X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0648204 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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