Healthcare Provider Details

I. General information

NPI: 1003806761
Provider Name (Legal Business Name): MEGGAN CLAIR HEINZ O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 FEDERAL ROAD
MONROE TOWNSHIP NJ
08831
US

IV. Provider business mailing address

155 FEDERAL ROAD
MONROE TOWNSHIP NJ
08831
US

V. Phone/Fax

Practice location:
  • Phone: 732-213-3894
  • Fax:
Mailing address:
  • Phone: 732-213-3894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00597900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: