Healthcare Provider Details

I. General information

NPI: 1710966585
Provider Name (Legal Business Name): LIZBETH J KUHN HEMMELGARN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E LAKE AVE
NEW CARLISLE OH
45344-1417
US

IV. Provider business mailing address

102 E LAKE AVE
NEW CARLISLE OH
45344-1417
US

V. Phone/Fax

Practice location:
  • Phone: 937-845-0751
  • Fax: 937-845-2931
Mailing address:
  • Phone: 937-845-0751
  • Fax: 937-845-2931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5397/T2308
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: