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General NPI Number Information
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NPI Number | 1720086267
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Entity Type | Individual
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Provider Name | HEATHER ROSS PAGE OD
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Gender | Female
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 22 EXECUTIVE DR
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City | TOMPKINSVILLE
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State | KY
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Zip | 42167-7478
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Country | US
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Telephone | 270-487-5741
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Fax | 270-487-9664
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Provider Business Mailing Address
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Address Line | 22 EXECUTIVE DR
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City | TOMPKINSVILLE
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State | KY
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Zip | 42167-7478
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Country | US
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Telephone | 270-487-5741
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Fax | 270-487-9664
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1557
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License Number State | KY
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