Healthcare Provider Details

I. General information

NPI: 1578188660
Provider Name (Legal Business Name): REBECCA ELLEN HEAPS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W 42ND ST
NEW YORK NY
10036-8005
US

IV. Provider business mailing address

110 COMMONS PARK N APT 1061
STAMFORD CT
06902-7182
US

V. Phone/Fax

Practice location:
  • Phone: 212-938-4001
  • Fax:
Mailing address:
  • Phone: 201-663-3032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV009157
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: