Healthcare Provider Details

I. General information

NPI: 1154241255
Provider Name (Legal Business Name): HERITAGE GLASS OPTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 WOODLAND CRES
FAIRMONT WV
26554-1420
US

IV. Provider business mailing address

1202 WOODLAND CRES
FAIRMONT WV
26554-1420
US

V. Phone/Fax

Practice location:
  • Phone: 304-694-4808
  • Fax:
Mailing address:
  • Phone: 304-694-4808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER M SIGLEY
Title or Position: OWNER
Credential:
Phone: 304-694-4808