MEDICARE: DR. HEATHER RENEE GEBHART 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	5018	OH
2	152WP0200X	Pediatric Optometrist	5018	OH
3	152WV0400X	Vision Therapy Optometrist	5018	OH

General Provider Information

NPI Number	:	1881655306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER RENEE GEBHART O.D.

Provider Business Mailing Address
First Line	:	5123 NORWICH ST
Second Line	:	SUITE 120
City	:	HILLIARD
State	:	OH
Zip	:	43026-1486
Country	:	US
Telephone Number	:	614-850-6151
Fax Number	:	614-850-7052

Provider Business Practice Location Address
First Line	:	5123 NORWICH ST
Second Line	:	SUITE 120
City	:	HILLIARD
State	:	OH
Zip	:	43026-1486
Country	:	US
Telephone Number	:	614-850-6151
Fax Number	:	614-850-7052

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

Provider Enumeration Date	:	04/01/2006
Last Update Date	:	09/01/2009

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