Basic Information
| Provider Information | |||||||||
| NPI: | 1518010842 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANDERSON HILLS EYE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7815 BEECHMONT AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452554207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133884000 | ||||||||
| FaxNumber: | 5133884007 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 HOME ST | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451211478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373780031 | ||||||||
| FaxNumber: | 9373781337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 11/14/2007 | ||||||||
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| AuthorizedOfficialLastName: | HOWARD | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5133884000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 0561664 | 05 | OH | MEDICAID |