Provider Demographics
NPI:1669596839
Name:DOUGLAS O. CHARTERS & KENNETH L. HIEB
Entity type:Organization
Organization Name:DOUGLAS O. CHARTERS & KENNETH L. HIEB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LYLE
Authorized Official - Last Name:HIEB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:559-733-9966
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:559-733-9966
Mailing Address - Fax:559-625-8913
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:559-733-9966
Practice Address - Fax:559-625-8913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA422920001OtherMEDICARE D.M.E. GROUP I.D
CAZZZ75398ZMedicaid
CAZZZ75398ZMedicaid
CA422920001OtherMEDICARE D.M.E. GROUP I.D