Provider Demographics
NPI:1043313695
Name:HECKMAN, CHRISTA (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:
Last Name:HECKMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MINSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45865-1335
Mailing Address - Country:US
Mailing Address - Phone:419-628-3017
Mailing Address - Fax:419-682-8208
Practice Address - Street 1:2765 FORT AMANDA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-4805
Practice Address - Country:US
Practice Address - Phone:419-228-3937
Practice Address - Fax:419-882-3939
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5555 T2465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2600868Medicaid
OH9264783Medicare PIN
OHV05862Medicare UPIN
OH4164721Medicare ID - Type Unspecified