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NPI Code Detail

MEDICARE: DR. BARBARA JUNE HETRICK O.D.

MEDICARE:  DR. BARBARA JUNE HETRICK  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
1152W00000XOptometristODP-890ID
2152W00000XOptometristOD00003039WA

General Provider Information

NPI Number : 1710971528
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BARBARA JUNE HETRICK O.D.
Provider Business Mailing Address
First Line : 395 YELLOWHAWK ST
Second Line :
City : WALLA WALLA
State : WA
Zip : 99362-7725
Country : US
Telephone Number : 509-525-2561
Fax Number :
Provider Business Practice Location Address
First Line : 77 WAINWRIGHT DR
Second Line : VAMC EYE CLINIC, 123
City : WALLA WALLA
State : WA
Zip : 99362-3975
Country : US
Telephone Number : 509-527-3491
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2005
Last Update Date : 07/09/2007

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