Provider Demographics
NPI:1366462251
Name:HIRSCHL, JEFFREY GILBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GILBERT
Last Name:HIRSCHL
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 1:8277 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6255
Mailing Address - Country:US
Mailing Address - Phone:330-726-5544
Mailing Address - Fax:330-758-3874
Practice Address - Street 1:8277 MARKET ST
Practice Address - Street 2:SUITE B
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6246
Practice Address - Country:US
Practice Address - Phone:330-726-5544
Practice Address - Fax:330-758-3874
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3863152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0642791Medicaid
OH341605571027OtherCARESOURCE
OH2200218OtherUNITED HEALTH CARE
OH410009219OtherRAILROAD MEDICARE
OH000000226428OtherANTHEM BC/BS
OH410009219OtherRAILROAD MEDICARE
OH0595444Medicare PIN
OH000000226428OtherANTHEM BC/BS