MEDICARE: JULIE M HEIDISH OD INC

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	4661	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1306843727	OTHER	OH	INDIVIDUAL NPI
2	1851584148	OTHER	OH	GROUP NPI
3	1669509428	OTHER	OH	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1851584148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JULIE M HEIDISH OD INC

Provider Business Mailing Address
First Line	:	3384 STATE ROUTE 752
Second Line	:
City	:	ASHVILLE
State	:	OH
Zip	:	43103-9685
Country	:	US
Telephone Number	:	740-983-6171
Fax Number	:	740-983-6587

Provider Business Practice Location Address
First Line	:	3384 STATE ROUTE 752
Second Line	:
City	:	ASHVILLE
State	:	OH
Zip	:	43103-9685
Country	:	US
Telephone Number	:	740-983-6171
Fax Number	:	740-983-6587

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JULIE M. HEIDISH
Credential	:	O.D.
Telephone Number	:	740-983-6171

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	12/26/2012

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Directions to “JULIE M HEIDISH OD INC ” Practice Location

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