Healthcare Provider Details

I. General information

NPI: 1750350807
Provider Name (Legal Business Name): GARY RANDAL HESS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 W WASHINGTON ST
ROCHESTER PA
15074-2242
US

IV. Provider business mailing address

171 W WASHINGTON ST P.O. BOX 86
ROCHESTER PA
15074-2242
US

V. Phone/Fax

Practice location:
  • Phone: 724-775-3051
  • Fax: 724-774-5522
Mailing address:
  • Phone: 724-775-3051
  • Fax: 724-774-5522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000677
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: