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General NPI Number Information
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NPI Number | 1114095312
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Entity Type | Organization
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Legal Business Name | HEITZ OPTICAL INC
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 2415 HOMER M ADAMS PKWY
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City | ALTON
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State | IL
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Zip | 62002-5615
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Country | US
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Telephone | 618-465-1712
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Fax | 618-465-3114
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Provider Business Mailing Address
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Address Line | 2415 HOMER M ADAMS PKWY P.O. BOX 598
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City | ALTON
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State | IL
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Zip | 62002-5615
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Country | US
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Telephone | 618-465-1712
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Fax | 618-465-3114
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Authorized Official
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Title or Position | OWNER
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Name | MR. DREW RINACKE
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Credential |
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Telephone | 618-465-1712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 1645-6246
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License Number State | IL
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