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General NPI Number Information
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NPI Number | 1760381123
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Entity Type | Organization
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Legal Business Name | VON SCOTT HIENEMAN
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Dates
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Enumeration Date | 11/03/2026
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Last Update Date | 11/03/2026
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Provider Practice Location Address
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Address Line | 6739 FULTON ST E STE A-20
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City | ADA
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State | MI
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Zip | 49301-8139
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Country | US
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Telephone | 616-676-2015
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Fax |
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Provider Business Mailing Address
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Address Line | 6739 FULTON ST E STE A-20
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City | ADA
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State | MI
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Zip | 49301-8139
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VON SCOTT HIENEMAN
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Credential | OD
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Telephone | 616-915-6439
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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 |
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License Number State |
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