=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518218494
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERIN R HECKMAN OD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2012
-----------------------------------------------------
Last Update Date | 10/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4616 HIGHWAY 280
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35242-5028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-408-4069
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4616 HIGHWAY 280
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35242-5028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNERS
-----------------------------------------------------
Name | ERIN HECKMAN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 205-408-4069
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | S-C30-TA-852
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------