Provider Demographics
NPI:1710054309
Name:TRISTATE CENTERS FOR SIGHT, INC.
Entity type:Organization
Organization Name:TRISTATE CENTERS FOR SIGHT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BARBERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-344-2062
Mailing Address - Street 1:2865 CHANCELLOR DR STE 215
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3931
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5571 CHEVIOT RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-7020
Practice Address - Country:US
Practice Address - Phone:513-389-9911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100002110 OMedicaid
OH0400506Medicaid
OH0400506Medicaid