Basic Information
Provider Information
NPI: 1659448256
EntityType: 2
ReplacementNPI:  
OrganizationName: TRISTATE CENTERS FOR SIGHT, INC.
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Mailing Information
Address1: PO BOX 631662
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452631662
CountryCode: US
TelephoneNumber: 8595817120
FaxNumber: 8595817207
Practice Location
Address1: 7815 BEECHMONT AVE
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452554207
CountryCode: US
TelephoneNumber: 5133884000
FaxNumber: 5133884007
Other Information
ProviderEnumerationDate: 11/29/2006
LastUpdateDate: 11/13/2007
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AuthorizedOfficialLastName: NORDLOH
AuthorizedOfficialFirstName: DANIEL
AuthorizedOfficialMiddleName: A
AuthorizedOfficialTitleorPosition: ADMINISTRATOR
AuthorizedOfficialTelephone: 8595817120
IsSoleProprietor:  
IsOrganizationSubpart: N
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOphthalmology 

ID Information
IDTypeStateIssuerDescription
018839005OH MEDICAID


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