Healthcare Provider Details

I. General information

NPI: 1841469376
Provider Name (Legal Business Name): HERITAGE FAMILY EYE CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5123 NORWICH ST SUITE 120
HILLIARD OH
43026-1486
US

IV. Provider business mailing address

5123 NORWICH ST SUITE 120
HILLIARD OH
43026-1486
US

V. Phone/Fax

Practice location:
  • Phone: 614-850-6151
  • Fax: 614-850-7052
Mailing address:
  • Phone: 614-850-6151
  • Fax: 614-850-7052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number5626
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number5018
License Number StateOH

VIII. Authorized Official

Name: DR. HEATHER R GEBHART
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 614-850-6151