Provider Demographics
NPI:1790089837
Name:RED BANK EYE ASSOCIATE, LLC
Entity Type:Organization
Organization Name:RED BANK EYE ASSOCIATE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-351-9768
Mailing Address - Street 1:4060 WATERFORD WAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1956
Mailing Address - Country:US
Mailing Address - Phone:513-753-0953
Mailing Address - Fax:
Practice Address - Street 1:4000 RED BANK RD
Practice Address - Street 2:@WAL-MART VISION CENTER
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-3416
Practice Address - Country:US
Practice Address - Phone:513-351-9768
Practice Address - Fax:513-351-9809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4165152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty