Provider Demographics
NPI:1821028523
Name:CINCINNATI EYE CARE TEAM LLC
Entity Type:Organization
Organization Name:CINCINNATI EYE CARE TEAM LLC
Other - Org Name:CINCINNATI EYECARE TEAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:WATKINS
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:O,D
Authorized Official - Phone:513-860-0400
Mailing Address - Street 1:2915 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-2402
Mailing Address - Country:US
Mailing Address - Phone:513-872-2028
Mailing Address - Fax:513-872-2122
Practice Address - Street 1:2915 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2402
Practice Address - Country:US
Practice Address - Phone:513-872-2028
Practice Address - Fax:513-872-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4738760002Medicare NSC
OH9332461Medicare PIN