Provider Demographics
NPI:1083639413
Name:HEFFLER, SARA S (OD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:S
Last Name:HEFFLER
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 1:1319 VIVIAN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3216
Mailing Address - Country:US
Mailing Address - Phone:303-772-3611
Mailing Address - Fax:303-772-3609
Practice Address - Street 1:1319 VIVIAN ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3216
Practice Address - Country:US
Practice Address - Phone:303-772-3611
Practice Address - Fax:303-772-3609
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1711152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC69044Medicare PIN