Provider Demographics
NPI:1033377866
Name:HEFFRON FAMILY EYE CARE, PLLC
Entity Type:Organization
Organization Name:HEFFRON FAMILY EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMISON
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEFFRON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-629-2015
Mailing Address - Street 1:507 S L ROGERS WELLS BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1043
Mailing Address - Country:US
Mailing Address - Phone:270-629-2015
Mailing Address - Fax:270-629-2016
Practice Address - Street 1:507 S L ROGERS WELLS BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1043
Practice Address - Country:US
Practice Address - Phone:270-629-2015
Practice Address - Fax:270-629-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7701319100Medicaid
KYU60640Medicare UPIN
6131720001Medicare NSC