Provider Demographics
NPI:1689663494
Name:HESS, JAMES N JR (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:N
Last Name:HESS
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12345 WAKE FOREST RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1500
Mailing Address - Country:US
Mailing Address - Phone:410-531-7507
Mailing Address - Fax:410-531-8655
Practice Address - Street 1:12345 WAKE FOREST RD
Practice Address - Street 2:SUITE E
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1500
Practice Address - Country:US
Practice Address - Phone:410-531-7507
Practice Address - Fax:410-531-8655
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDTA1214152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5271500002Medicare NSC
MDU58699Medicare UPIN
MD583LMedicare ID - Type Unspecified