Provider Demographics
NPI:1235226085
Name:KIRSTEIN, ELLIOT MARC (OD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:MARC
Last Name:KIRSTEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8211 CORNELL RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2235
Mailing Address - Country:US
Mailing Address - Phone:513-530-0440
Mailing Address - Fax:513-530-0473
Practice Address - Street 1:8211 CORNELL ROAD
Practice Address - Street 2:SUITE 510
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2235
Practice Address - Country:US
Practice Address - Phone:513-530-0440
Practice Address - Fax:513-530-0473
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3248-T514152W00000X
OH3248152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0309768Medicaid
KI0428052Medicare PIN
T46816Medicare UPIN
OH0190450001Medicare NSC