MEDICARE: LCD PROFESSIONALS,PC

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	0994	AZ

General Provider Information

NPI Number	:	1285802975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LCD PROFESSIONALS,PC

Provider Business Mailing Address
First Line	:	4925 S ALMA SCHOOL RD
Second Line	:	SUITE 1
City	:	CHANDLER
State	:	AZ
Zip	:	85248-5635
Country	:	US
Telephone Number	:	480-510-2049
Fax Number	:

Provider Business Practice Location Address
First Line	:	4925 S ALMA SCHOOL RD
Second Line	:	SUITE 1
City	:	CHANDLER
State	:	AZ
Zip	:	85248-5635
Country	:	US
Telephone Number	:	480-510-2049
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	CHRISTOPHER GRANT HEETLAND
Credential	:	OD
Telephone Number	:	480-510-2049

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	02/14/2008

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