MEDICARE: DR. JAMES N HESS JR. O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TA1214	MD

General Provider Information

NPI Number	:	1689663494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES N HESS JR. O.D.

Provider Business Mailing Address
First Line	:	12345 WAKE FOREST RD
Second Line	:	SUITE E
City	:	CLARKSVILLE
State	:	MD
Zip	:	21029-1500
Country	:	US
Telephone Number	:	410-531-7507
Fax Number	:	410-531-8655

Provider Business Practice Location Address
First Line	:	12345 WAKE FOREST RD
Second Line	:	SUITE E
City	:	CLARKSVILLE
State	:	MD
Zip	:	21029-1500
Country	:	US
Telephone Number	:	410-531-7507
Fax Number	:	410-531-8655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	12/11/2012

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