Tri State Ocular Prosthetics, LLC

Primary specialty

OcularistTaxonomy code 156FX1700X

License

O.11 Issued in OH

Legal business name

TRI STATE OCULAR PROSTHETICS, LLC

Practice address

130 Tri County Pkwy
Suite 201
Cincinnati, OH 45246-3289

Phone

(513) 771-6029

Fax

(513) 771-6187

NPI assigned

Feb 1, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Andrew W Hetzler, B.C.O., B.A.D.O.NPI 1538916820

Title

President

Phone

(513) 310-2060

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrew Hetzler, BCO, BS

  • Ocularist
  • Cincinnati, OH
  • NPI 1538916820
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468195200000",
    "number": "1205974516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 TRI COUNTY PKWY",
            "address_2": "SUITE 201",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452463289",
            "telephone_number": "513-771-6029",
            "fax_number": "513-771-6187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 TRI COUNTY PKWY",
            "address_2": "SUITE 201",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452463289",
            "telephone_number": "513-771-6029",
            "fax_number": "513-771-6187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI STATE OCULAR PROSTHETICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2016-07-11",
        "status": "A",
        "authorized_official_last_name": "HETZLER",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "513-310-2060",
        "authorized_official_credential": "B.C.O., B.A.D.O."
    },
    "taxonomies": [
        {
            "code": "156FX1700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Ocularist",
            "state": "OH",
            "license": "O.11",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0063218",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100005950",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "511527",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tri Health Senior Link
• Tri State Community Health Limted
• Tri State Diagnostic Services , Inc
• Tri State Health Systems
• Tri State Medicare Providers
• Tri State Primary Care LLC
• Tri State Travel Health LLC
• Tri State Urgent Care LLC
• Tri State Urologic Services PSC
• Tri State Urologic Services PSC Inc

• Ocularist in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Ocularist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.