Healthcare Provider Details

I. General information

NPI: 1114270444
Provider Name (Legal Business Name): HEITMEIER PHYSICIANS OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MEDICAL CENTER BLVD SUITE 111
MARRERO LA
70072-3151
US

IV. Provider business mailing address

3501 HOLIDAY DR SUITE 201
NEW ORLEANS LA
70114-8202
US

V. Phone/Fax

Practice location:
  • Phone: 504-349-6213
  • Fax:
Mailing address:
  • Phone: 504-368-7081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateLA

VIII. Authorized Official

Name: DAVID HEITMEIER
Title or Position: PRESIDENT
Credential: OD
Phone: 504-368-7081