Healthcare Provider Details

I. General information

NPI: 1144298456
Provider Name (Legal Business Name): MICHELLE HEJNY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GATE CITY HWY SPACE 405
BRISTOL VA
24201-2372
US

IV. Provider business mailing address

2829 E OAKLAND AVE #1
JOHNSON CITY TN
37601-1347
US

V. Phone/Fax

Practice location:
  • Phone: 276-466-6173
  • Fax: 276-669-0570
Mailing address:
  • Phone: 423-283-4590
  • Fax: 423-283-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000563
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: