Provider Demographics
NPI:1003924374
Name:HEASTON, DALE D (OD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:D
Last Name:HEASTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 AARON DR
Mailing Address - Street 2:PO BOX 610
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4678
Mailing Address - Country:US
Mailing Address - Phone:509-943-3171
Mailing Address - Fax:509-946-0905
Practice Address - Street 1:1321 AARON DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4678
Practice Address - Country:US
Practice Address - Phone:509-943-3171
Practice Address - Fax:509-946-0905
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1129152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4100016629OtherRAILROAD MEDICARE
HE6761OtherBLUE CROSS BLUE SHIELD
11102OtherGROUP HEALTH
WA0144211OtherWA LABOR & INDUSTRY
WA0144211OtherWA LABOR & INDUSTRY
U22117Medicare UPIN
G319211100Medicare PIN