Organization
TRI STATE OCULAR PROSTHETICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW W HETZLER B.C.O., B.A.D.O. (PRESIDENT)
(513) 310-2060
Entity
Organization
Contact information
Practice address
130 TRI COUNTY PKWY, SUITE 201, CINCINNATI, OH 45246-3289
(513) 771-6029
(513) 771-6187
Mailing address
130 TRI COUNTY PKWY, SUITE 201, CINCINNATI, OH 45246-3289
(513) 771-6029
(513) 771-6187
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
Primary
O.11
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0063218
—
OH
01
—
511527
ANTHEM
OH
05
—
7100005950
—
KY
Enumeration date
02/01/2007
Last updated
07/11/2016
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