Provider Demographics
NPI:1144233776
Name:PRYOR, CHESTER CORNELIUS II (MD)
Entity type:Individual
Prefix:
First Name:CHESTER
Middle Name:CORNELIUS
Last Name:PRYOR
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2399
Mailing Address - Country:US
Mailing Address - Phone:513-558-0815
Mailing Address - Fax:
Practice Address - Street 1:2828 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2399
Practice Address - Country:US
Practice Address - Phone:513-558-0815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35P21026207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH429554OtherBWC EMPLOYEE
OH7103888Medicaid
OHPRO108641Medicare ID - Type Unspecified
C00332Medicare UPIN