MEDICARE: DR. CHRISTA HECKMAN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5555 T2465	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043313695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTA HECKMAN O.D.

Provider Business Mailing Address
First Line	:	718 OAKWOOD DR
Second Line	:
City	:	MINSTER
State	:	OH
Zip	:	45865-1335
Country	:	US
Telephone Number	:	419-628-3017
Fax Number	:	419-682-8208

Provider Business Practice Location Address
First Line	:	2765 FORT AMANDA RD
Second Line	:	SUITE 100
City	:	LIMA
State	:	OH
Zip	:	45805-4805
Country	:	US
Telephone Number	:	419-228-3937
Fax Number	:	419-882-3939

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	12/16/2008

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