Healthcare Provider Details

I. General information

NPI: 1306838610
Provider Name (Legal Business Name): RICHARD JAMES HETSKO AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W LORAIN ST SUITE D
OBERLIN OH
44074-1096
US

IV. Provider business mailing address

118 CYPRESS ST
OBERLIN OH
44074-1473
US

V. Phone/Fax

Practice location:
  • Phone: 440-774-5819
  • Fax: 440-774-5920
Mailing address:
  • Phone: 440-775-1083
  • Fax: 440-774-5920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA0006
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: