Provider Demographics
NPI:1689335598
Name:HEGLER, ICSIS UNIIQUE
Entity Type:Individual
Prefix:
First Name:ICSIS
Middle Name:UNIIQUE
Last Name:HEGLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ICSIS
Other - Middle Name:UNIIQUE
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19251 MACK AVE STE M450
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2893
Mailing Address - Country:US
Mailing Address - Phone:313-343-1370
Mailing Address - Fax:438-124-8712
Practice Address - Street 1:19251 MACK AVE STE M450
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2893
Practice Address - Country:US
Practice Address - Phone:313-343-1370
Practice Address - Fax:438-124-8712
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist