=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114937604
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHERINE A HESS O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2006
-----------------------------------------------------
Last Update Date | 03/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 423 E MAIN ST
-----------------------------------------------------
City | MIDDLEBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17842-1215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-837-0112
-----------------------------------------------------
Fax | 570-837-3587
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 423 E MAIN ST
-----------------------------------------------------
City | MIDDLEBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17842-1215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-837-0112
-----------------------------------------------------
Fax | 570-837-3587
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OEG001806
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------