Basic Information
| Provider Information | |||||||||
| NPI: | 1164894473 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CEI PHYSICIANS PSC, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4445 LAKE FOREST DR STE 600 | ||||||||
| Address2: | |||||||||
| City: | BLUE ASH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452423744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135693741 | ||||||||
| FaxNumber: | 5135693941 | ||||||||
| Practice Location | |||||||||
| Address1: | 6507 HARRISON AVE | ||||||||
| Address2: | SUITE E | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452472816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136613566 | ||||||||
| FaxNumber: | 5136616469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2015 | ||||||||
| LastUpdateDate: | 09/29/2020 | ||||||||
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| AuthorizedOfficialLastName: | KNIGHT | ||||||||
| AuthorizedOfficialFirstName: | TERI | ||||||||
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| AuthorizedOfficialTitleorPosition: | SN CREDENTIALS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5135693741 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | 83035181 | OH | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.