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NPI Code Detail

MEDICARE: DR. CHRISTOPHER GRANT HEETLAND O.D.

MEDICARE:  DR. CHRISTOPHER GRANT HEETLAND  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
1152W00000XOptometrist994AZ

General Provider Information

NPI Number : 1609875301
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTOPHER GRANT HEETLAND O.D.
Provider Business Mailing Address
First Line : 4925 S ALMA SCHOOL RD
Second Line : STE. #1
City : CHANDLER
State : AZ
Zip : 85248-5635
Country : US
Telephone Number : 480-883-0900
Fax Number : 480-883-1901
Provider Business Practice Location Address
First Line : 4925 S ALMA SCHOOL RD
Second Line : STE. #1
City : CHANDLER
State : AZ
Zip : 85248-5635
Country : US
Telephone Number : 480-883-0900
Fax Number : 480-883-1901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2005
Last Update Date : 08/16/2012

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Directions to “ DR. CHRISTOPHER GRANT HEETLAND O.D.” Practice Location

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