Provider Demographics
NPI:1073889184
Name:CHILDREN'S EYE PHYSICIANS
Entity Type:Organization
Organization Name:CHILDREN'S EYE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-680-6004
Mailing Address - Street 1:9302 TOWNE SQUARE AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6943
Mailing Address - Country:US
Mailing Address - Phone:513-791-2114
Mailing Address - Fax:513-791-3672
Practice Address - Street 1:9302 TOWNE SQUARE AVE
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6943
Practice Address - Country:US
Practice Address - Phone:513-791-2114
Practice Address - Fax:513-791-3672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051262156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0571377OtherOH BCMH
KY64784424Medicaid
OH0571377Medicaid
IN163181OtherINDIANA BCMH
OHSZ0562744Medicare PIN
KY64784424Medicaid