=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568467074
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HETZLER OCULAR PROSTHETIC, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2005
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 TRI COUNTY PKWY STE 201
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45246-3235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-771-6029
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 TRI COUNTY PKWY STE 201
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45246-3235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-771-6029
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. KATHY J HETZLER
-----------------------------------------------------
Credential | B.C.O.
-----------------------------------------------------
Telephone | 317-598-6298
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | O.11
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 156FX1700X
-----------------------------------------------------
Taxonomy Name | Ocularist
-----------------------------------------------------
License Number | 0.11
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------