Healthcare Provider Details

I. General information

NPI: 1518963842
Provider Name (Legal Business Name): LINDA L HEISEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GRANITE POINT DR STE 100
WYOMISSING PA
19610-1986
US

IV. Provider business mailing address

1 GRANITE POINT DR SUITE 100
READING PA
19610-1986
US

V. Phone/Fax

Practice location:
  • Phone: 610-378-1344
  • Fax: 610-378-5159
Mailing address:
  • Phone: 610-378-1344
  • Fax: 610-378-5169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000735
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: