Provider Demographics
NPI:1053659839
Name:TRI-STATE CENTERS FOR SIGHT, INC.
Entity Type:Organization
Organization Name:TRI-STATE CENTERS FOR SIGHT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:NORDLOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-344-2061
Mailing Address - Street 1:2865 CHANCELLOR DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3912
Mailing Address - Country:US
Mailing Address - Phone:859-581-7120
Mailing Address - Fax:859-581-7207
Practice Address - Street 1:7527 STATE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-6407
Practice Address - Country:US
Practice Address - Phone:513-381-1900
Practice Address - Fax:513-287-6403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0079712Medicaid
OH0079712Medicaid
OH9341751Medicare PIN