Provider Demographics
NPI:1962471458
Name:HEIBY, FRIEDRICH JOHANNES (OD)
Entity Type:Individual
Prefix:DR
First Name:FRIEDRICH
Middle Name:JOHANNES
Last Name:HEIBY
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 1:2983 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1430
Mailing Address - Country:US
Mailing Address - Phone:740-450-8100
Mailing Address - Fax:
Practice Address - Street 1:1038 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-3029
Practice Address - Country:US
Practice Address - Phone:740-453-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4936152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2420053Medicaid
OH4109402Medicare PIN
OH2420053Medicaid