Provider Demographics
NPI:1568467074
Name:HETZLER OCULAR PROSTHETIC, INC
Entity Type:Organization
Organization Name:HETZLER OCULAR PROSTHETIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HETZLER
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:317-598-6298
Mailing Address - Street 1:130 TRI COUNTY PKWY
Mailing Address - Street 2:STE 201
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3235
Mailing Address - Country:US
Mailing Address - Phone:513-771-6029
Mailing Address - Fax:
Practice Address - Street 1:130 TRI COUNTY PKWY
Practice Address - Street 2:STE 201
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3235
Practice Address - Country:US
Practice Address - Phone:513-771-6029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0.11156FX1700X
OHO.11335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
Not Answered335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2046995Medicaid
OHA1789OtherCHOICECARE
OH000000029685OtherANTHEM BCBS
KY90000902Medicaid
OH0171820002Medicare ID - Type Unspecified