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NPI Code Detail

MEDICARE: DR. JAY A HEILMANN O.D.

MEDICARE: DR. JAY A HEILMANN 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
1152W00000XOptometrist2430WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14314611OTHERWIAETNA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932192440
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAY A HEILMANN O.D.
Provider Business Mailing Address
First Line : 1684 N PROSPECT AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-2408
Country : US
Telephone Number : 414-271-2020
Fax Number : 414-272-3932
Provider Business Practice Location Address
First Line : 1684 N PROSPECT AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-2408
Country : US
Telephone Number : 414-271-2020
Fax Number : 414-272-3932
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2005
Last Update Date : 01/16/2008

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