MEDICARE: DR. BETH HEINZ OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4098-35	WI

General Provider Information

NPI Number	:	1023992435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETH HEINZ OD

Provider Business Mailing Address
First Line	:	10320 N PHEASANT LN
Second Line	:
City	:	HAYWARD
State	:	WI
Zip	:	54843-7662
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15569 RAILROAD ST STE 301
Second Line	:
City	:	HAYWARD
State	:	WI
Zip	:	54843-5707
Country	:	US
Telephone Number	:	715-634-8616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2025
Last Update Date	:	07/31/2025

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