Provider Demographics
NPI:1851366348
Name:HIEB, KENNETH LYLE (OD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LYLE
Last Name:HIEB
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 1:3749 S MOONEY BLVD
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8000
Mailing Address - Country:US
Mailing Address - Phone:559-434-9812
Mailing Address - Fax:559-434-9828
Practice Address - Street 1:3749 S MOONEY BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8000
Practice Address - Country:US
Practice Address - Phone:559-434-9812
Practice Address - Fax:559-434-9828
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5283T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0052830Medicaid
CAT09931Medicare UPIN