MEDICARE: HEARTLAND VISION CENTER PA

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

General Provider Information

NPI Number	:	1215075973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND VISION CENTER PA

Provider Business Mailing Address
First Line	:	2305 S TUCKER ST
Second Line	:
City	:	PITTSBURG
State	:	KS
Zip	:	66762-6530
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2305 S TUCKER ST
Second Line	:
City	:	PITTSBURG
State	:	KS
Zip	:	66762-6530
Country	:	US
Telephone Number	:	620-232-2020
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	DR. DUSTIN JAMES BROOKS
Credential	:	O.D.
Telephone Number	:	620-232-2020

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	12/05/2007

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Directions to “HEARTLAND VISION CENTER PA ” Practice Location

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