Provider Demographics
NPI:1801075379
Name:DR. MALINDA PENCE & ASSOCIATES, INC
Entity type:Organization
Organization Name:DR. MALINDA PENCE & ASSOCIATES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MALINDA
Authorized Official - Middle Name:BERNING
Authorized Official - Last Name:PENCE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-561-7076
Mailing Address - Street 1:6725 MIAMI AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-3158
Mailing Address - Country:US
Mailing Address - Phone:513-561-7076
Mailing Address - Fax:513-561-2066
Practice Address - Street 1:6725 MIAMI AVE STE 101
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-3158
Practice Address - Country:US
Practice Address - Phone:513-561-7076
Practice Address - Fax:513-561-2066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5060152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9329031Medicare PIN
OHU84277Medicare UPIN