Organization
TRI-STATE PEDIATRIC OPHTHALMOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH M GAINER MD (OWNER)
(740) 633-6671
Entity
Organization
Contact information
Practice address
222 N 5TH ST, SUITE 201, MARTINS FERRY, OH 43935-1582
(740) 633-6671
(740) 633-6679
Mailing address
222 N 5TH ST, SUITE 201, MARTINS FERRY, OH 43935-1582
(740) 633-6671
(740) 633-6679
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
20425
WV
207W00000X
Ophthalmology Physician
Primary
35-84204
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2003963000
—
WV
05
—
2524209
—
OH
Enumeration date
10/14/2005
Last updated
12/27/2007
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