# TRI-STATE PEDIATRIC OPHTHALMOLOGY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205825122
- **Authorized official:** DR. KENNETH M GAINER MD (OWNER)
- **Authorized official phone:** (740) 633-6671

## Contact information

- **Practice address:** 222 N 5TH ST, SUITE 201, MARTINS FERRY, OH 43935-1582
- **Practice address phone:** (740) 633-6671
- **Practice address fax:** (740) 633-6679
- **Mailing address:** 222 N 5TH ST, SUITE 201, MARTINS FERRY, OH 43935-1582
- **Mailing address phone:** (740) 633-6671
- **Mailing address fax:** (740) 633-6679

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 20425 | WV | — |
| 207W00000X | Ophthalmology Physician | 35-84204 | OH | Yes |

## Other

- **Enumeration date:** 10/14/2005
- **Last updated:** 12/27/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2003963000 | — | WV |
| 05 | — | 2524209 | — | OH |