Provider Demographics
NPI:1316638315
Name:HEGLER, BRIAN SCOTT (LDO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:SCOTT
Last Name:HEGLER
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 ZEBULON RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2030
Mailing Address - Country:US
Mailing Address - Phone:478-471-9011
Mailing Address - Fax:478-471-9042
Practice Address - Street 1:5955 ZEBULON RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2030
Practice Address - Country:US
Practice Address - Phone:478-471-9011
Practice Address - Fax:478-471-9042
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002782156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician