Provider Demographics
NPI:1164894473
Name:CEI PHYSICIANS PSC, LLC
Entity Type:Organization
Organization Name:CEI PHYSICIANS PSC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SN CREDENTIALS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-569-3741
Mailing Address - Street 1:4445 LAKE FOREST DR STE 600
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3744
Mailing Address - Country:US
Mailing Address - Phone:513-569-3741
Mailing Address - Fax:513-569-3941
Practice Address - Street 1:6507 HARRISON AVE
Practice Address - Street 2:SUITE E
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-2816
Practice Address - Country:US
Practice Address - Phone:513-661-3566
Practice Address - Fax:513-661-6469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH83035181332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier