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General NPI Number Information
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NPI Number | 1851584148
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Entity Type | Organization
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Legal Business Name | JULIE M HEIDISH OD INC
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 12/26/2012
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Provider Practice Location Address
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Address Line | 3384 STATE ROUTE 752
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City | ASHVILLE
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State | OH
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Zip | 43103-9685
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Country | US
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Telephone | 740-983-6171
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Fax | 740-983-6587
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Provider Business Mailing Address
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Address Line | 3384 STATE ROUTE 752
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City | ASHVILLE
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State | OH
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Zip | 43103-9685
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Country | US
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Telephone | 740-983-6171
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Fax | 740-983-6587
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JULIE M. HEIDISH
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Credential | O.D.
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Telephone | 740-983-6171
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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 | 4661
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License Number State | OH
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