MEDICARE: SHAWNA D. HEINTZ 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	MOT03259	MO

General Provider Information

NPI Number	:	1922115583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNA D. HEINTZ O.D.

Provider Business Mailing Address
First Line	:	4304 NE 57TH TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-4681
Country	:	US
Telephone Number	:	816-452-8979
Fax Number	:

Provider Business Practice Location Address
First Line	:	7201 NORTH M-1 HIGHWAY
Second Line	:
City	:	GLADSTONE
State	:	MO
Zip	:	64119
Country	:	US
Telephone Number	:	816-436-5834
Fax Number	:

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	07/08/2007

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