Provider Demographics
NPI:1114922218
Name:HIEBER, RANDALL R (OD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:R
Last Name:HIEBER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 HARDING WAY W
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-1725
Mailing Address - Country:US
Mailing Address - Phone:419-468-3355
Mailing Address - Fax:419-468-7475
Practice Address - Street 1:337 HARDING WAY W
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-1725
Practice Address - Country:US
Practice Address - Phone:419-468-3355
Practice Address - Fax:419-468-7475
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2010-06-29
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
OH3414/T925152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0411263Medicaid
OH0411263Medicaid
OH0286210001Medicare NSC