MEDICARE: DR. HEIDRUN GOLLOGLY M.D.

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	207W00000X	Ophthalmology Physician	105611	MN
2	207W00000X	Ophthalmology Physician	134761	CA
3	207W00000X	Ophthalmology Physician	54428	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477879823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEIDRUN GOLLOGLY M.D.

Provider Business Mailing Address
First Line	:	6333 MAIN ST
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-5800
Country	:	US
Telephone Number	:	716-632-3545
Fax Number	:	716-632-6368

Provider Business Practice Location Address
First Line	:	6333 MAIN ST
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-5800
Country	:	US
Telephone Number	:	716-632-3545
Fax Number	:

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

Provider Enumeration Date	:	04/09/2010
Last Update Date	:	02/17/2026

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