Healthcare Provider Details

I. General information

NPI: 1255539169
Provider Name (Legal Business Name): NICHOLAS AARON HESS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 E MAIN ST
MIDDLEBURG PA
17842-1215
US

IV. Provider business mailing address

611 PICNIC LN
SELINSGROVE PA
17870-9128
US

V. Phone/Fax

Practice location:
  • Phone: 570-837-0112
  • Fax:
Mailing address:
  • Phone: 570-765-8368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001925
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: