| |
2865 Chancellor Dr, Suite 215, Crestview Hills, KY 41017-3912 | |
(859) 581-7120 | |
(859) 581-7207 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 2865 Chancellor Dr, Crestview Hills, Kentucky |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1396886610 | NPI | - | NPPES |
36000321 | Medicaid | KY | |
0111751 | Medicaid | OH | |
65925760 | Medicaid | KY | |
77903425 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
207W00000X | Ophthalmology | (* (Not Available)) | Primary |
363L00000X | Nurse Practitioner | (Kentucky) | Secondary |
Mailing Address | Practice Location Address |
---|---|
Po Box 631662, Cincinnati, OH 45263-1662 Ph: (859) 581-7120 | 2865 Chancellor Dr, Suite 215, Crestview Hills, KY 41017-3912 Ph: (859) 581-7120 |