Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 14676 | OH |
NPI | 1174133466 |
---|---|
Provider Name | Mr. Robert James Hessler |
First Address | Amelia, OH 45102-2358 |
Second Address | Amelia, OH 45102-2358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2020 |
Last Update Date | 03/08/2020 |