=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235307224
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEOFFREY K. HEMMICK, OD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2008
-----------------------------------------------------
Last Update Date | 03/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 S MAIN ST
-----------------------------------------------------
City | LIGONIER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46767-1902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-894-3912
-----------------------------------------------------
Fax | 260-894-4098
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 S MAIN ST
-----------------------------------------------------
City | LIGONIER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46767-1902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-894-3912
-----------------------------------------------------
Fax | 260-894-4098
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | GEOFFREY K HEMMICK
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 260-894-3912
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------