Healthcare Provider Details

I. General information

NPI: 1033377866
Provider Name (Legal Business Name): HEFFRON FAMILY EYE CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 S L ROGERS WELLS BLVD SUITE E
GLASGOW KY
42141-1043
US

IV. Provider business mailing address

507 S L ROGERS WELLS BLVD SUITE E
GLASGOW KY
42141-1043
US

V. Phone/Fax

Practice location:
  • Phone: 270-629-2015
  • Fax: 270-629-2016
Mailing address:
  • Phone: 270-629-2015
  • Fax: 270-629-2016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMISON J HEFFRON
Title or Position: OWNER
Credential: O.D.
Phone: 270-629-2015