Provider Demographics
NPI:1083160915
Name:TRI-STATE DOCTORS OF
Entity Type:Organization
Organization Name:TRI-STATE DOCTORS OF
Other - Org Name:KY DOCTORS OF OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBESH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:726-444-4078
Mailing Address - Street 1:175 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2255
Mailing Address - Country:US
Mailing Address - Phone:210-524-6982
Mailing Address - Fax:
Practice Address - Street 1:7727 MALL RD
Practice Address - Street 2:STE. B
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1405
Practice Address - Country:US
Practice Address - Phone:859-282-1751
Practice Address - Fax:859-282-6928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier