MEDICARE: LINDA L HEISEY O.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	152W00000X	Optometrist	OEG000735	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410032353	OTHER	PA	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1518963842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA L HEISEY O.D.

Provider Business Mailing Address
First Line	:	1 GRANITE POINT DR
Second Line	:	SUITE 100
City	:	READING
State	:	PA
Zip	:	19610-1986
Country	:	US
Telephone Number	:	610-378-1344
Fax Number	:	610-378-5169

Provider Business Practice Location Address
First Line	:	1 GRANITE POINT DR
Second Line	:	STE 100
City	:	WYOMISSING
State	:	PA
Zip	:	19610-1986
Country	:	US
Telephone Number	:	610-378-1344
Fax Number	:	610-378-5159

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	06/24/2008

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Directions to “ LINDA L HEISEY O.D.” Practice Location

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