Healthcare Provider Details

I. General information

NPI: 1861527251
Provider Name (Legal Business Name): HEFFINGTON'S HOUSE OF VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E WOODHURST DR
SPRINGFIELD MO
65804-4281
US

IV. Provider business mailing address

PO BOX 774
SPRINGFIELD MO
65801-0774
US

V. Phone/Fax

Practice location:
  • Phone: 417-882-3937
  • Fax: 417-887-5166
Mailing address:
  • Phone: 417-869-3937
  • Fax: 417-869-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MARK HEFFINGTON
Title or Position: PRESIDENT
Credential: ABOC-FNAO
Phone: 417-882-3937