Provider Demographics
NPI:1497136873
Name:DONAHUE, ALYSSA (OD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5535 FAIR LN STE C
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-3440
Mailing Address - Country:US
Mailing Address - Phone:513-221-5274
Mailing Address - Fax:513-961-5100
Practice Address - Street 1:6150 RADIO WAY
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-4520
Practice Address - Country:US
Practice Address - Phone:513-770-4020
Practice Address - Fax:513-770-4021
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6366T3283152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0140601Medicaid