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General NPI Number Information
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NPI Number | 1114922218
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Entity Type | Individual
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Provider Name | RANDALL R HIEBER O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 337 HARDING WAY W
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City | GALION
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State | OH
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Zip | 44833-1725
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Country | US
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Telephone | 419-468-3355
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Fax | 419-468-7475
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Provider Business Mailing Address
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Address Line | 337 HARDING WAY W
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City | GALION
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State | OH
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Zip | 44833-1725
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Country | US
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Telephone | 419-468-3355
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Fax | 419-468-7475
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3414/T925
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License Number State | OH
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