Provider Demographics
NPI:1033498415
Name:HEDBERG, NICHOLAS JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JOHN
Last Name:HEDBERG
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1011 VALLEY RIVER WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2127
Mailing Address - Country:US
Mailing Address - Phone:541-229-8109
Mailing Address - Fax:541-229-8463
Practice Address - Street 1:5709 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-5426
Practice Address - Country:US
Practice Address - Phone:541-726-6822
Practice Address - Fax:541-229-8723
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR3425ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist