TRI-STATE CENTERS FOR SIGHT, INC.

Provider Demographics

• NPI: 1396886610
• Name: TRI-STATE CENTERS FOR SIGHT, INC.
• Entity type: Organization
• Organization Name: TRI-STATE CENTERS FOR SIGHT, INC.
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: CHIEF REVENUE CYCLE OFFICER
• Authorized Official - First Name: CANDICE
• Authorized Official - Middle Name: B
• Authorized Official - Last Name: DAVIS
• Authorized Official - Phone: 916-990-7590
• Mailing Address - Street 1: PO BOX 631662
• Mailing Address - City: CINCINNATI
• Mailing Address - State: OH
• Mailing Address - Zip Code: 45263-1662
• Mailing Address - Country: US
• Mailing Address - Phone: 859-581-7120
• Mailing Address - Fax: 859-581-7207
• Practice Address - Street 1: 2865 CHANCELLOR DR
• Practice Address - Street 2: SUITE 215
• Practice Address - City: CRESTVIEW HILLS
• Practice Address - State: KY
• Practice Address - Zip Code: 41017-3912
• Practice Address - Country: US
• Practice Address - Phone: 859-581-7120
• Practice Address - Fax: 859-581-7207
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2007-02-09
• Last Update Date: 2025-05-05

Provider Licenses

State	License ID	Taxonomies
		152W00000X, 207W00000X
KY		363L00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207W00000X	Allopathic & Osteopathic Physicians	Ophthalmology		Group - Single Specialty
No	152W00000X	Eye and Vision Services Providers	Optometrist		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
KY	77903425	Medicaid
KY	36000321	Medicaid
KY	65925760	Medicaid
OH	0111751	Medicaid
OH	9341753	Medicare PIN
KY	6511	Medicare PIN
KY	36000321	Medicaid
OH	9279282	Medicare PIN
OH	9279828	Medicare PIN
KY	3453	Medicare PIN
OH	9279287	Medicare PIN
OH	9285258	Medicare PIN
	CA6329	Medicare PIN
OH	0111751	Medicaid
KY	77903425	Medicaid
OH	9279281	Medicare PIN
OH	9279824	Medicare PIN
KY	3463	Medicare PIN
KY	CI4028	Medicare PIN
KY	3443	Medicare PIN
KY	65925760	Medicaid
OH	9279827	Medicare PIN
OH	9279829	Medicare PIN