Basic Information
| Provider Information | |||||||||
| NPI: | 1912966177 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOX | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5535 FAIR LN | ||||||||
| Address2: | SUITE C | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452273434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132215274 | ||||||||
| FaxNumber: | 5139615100 | ||||||||
| Practice Location | |||||||||
| Address1: | 6394 THORNBERRY CT | ||||||||
| Address2: | SUITE 810 | ||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450407810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137704020 | ||||||||
| FaxNumber: | 5137704021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 12/31/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 5034 T1911 | OH | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 410040182 | 01 | OH | RAILROAD MEDICARE | OTHER | 2118103 | 05 | OH | MEDICAID |