Provider Demographics
NPI:1972565737
Name:HETTLER, DAVID HOWARD (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HOWARD
Last Name:HETTLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6098 FRANCONIA RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-1742
Mailing Address - Country:US
Mailing Address - Phone:703-971-0544
Mailing Address - Fax:703-719-7627
Practice Address - Street 1:6098 FRANCONIA RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-1742
Practice Address - Country:US
Practice Address - Phone:703-971-0544
Practice Address - Fax:703-719-7627
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000063152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT31236Medicare UPIN