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General NPI Number Information
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NPI Number | 1497079644
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Entity Type | Organization
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Legal Business Name | HEIDI A HANISCH OD PC
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 04/27/2010
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Provider Practice Location Address
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Address Line | 3010 E 23RD ST
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City | FREMONT
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State | NE
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Zip | 68025-2479
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Country | US
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Telephone | 402-727-0804
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Fax | 402-727-6102
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Provider Business Mailing Address
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Address Line | PO BOX 241296
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City | OMAHA
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State | NE
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Zip | 68124-5296
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Country | US
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Telephone | 402-727-0804
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Fax | 402-727-6102
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Authorized Official
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Title or Position | OWNER
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Name | DR. HEIDI A HANISCH
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Credential | OD
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Telephone | 402-981-7802
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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 | 1033
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License Number State | NE
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