Healthcare Provider Details

I. General information

NPI: 1518606094
Provider Name (Legal Business Name): HEATHER CARLTON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 US HIGHWAY 95A S UNIT A
FERNLEY NV
89408-9261
US

IV. Provider business mailing address

1437 SAMS DR STE 101
CHESAPEAKE VA
23320-4587
US

V. Phone/Fax

Practice location:
  • Phone: 775-575-5700
  • Fax: 775-575-5702
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618003118
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1157
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: