Provider Demographics
NPI:1083767065
Name:FORD, HEATHER FLINT (OD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:FLINT
Last Name:FORD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:FORD
Other - Last Name:MCGINLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19490-0074
Mailing Address - Country:US
Mailing Address - Phone:610-584-5626
Mailing Address - Fax:610-584-5627
Practice Address - Street 1:3401 SKIPPACK PIKE BUILDING D1
Practice Address - Street 2:
Practice Address - City:CEDARS
Practice Address - State:PA
Practice Address - Zip Code:19423
Practice Address - Country:US
Practice Address - Phone:610-584-5626
Practice Address - Fax:610-584-5627
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000133152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU81308Medicare UPIN