Provider Demographics
NPI:1144203977
Name:HECK, GINA L (OD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:L
Last Name:HECK
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 1:2 E OCALA ST
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3907
Mailing Address - Country:US
Mailing Address - Phone:715-261-8500
Mailing Address - Fax:715-261-8667
Practice Address - Street 1:2 E OCALA ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3907
Practice Address - Country:US
Practice Address - Phone:715-261-8500
Practice Address - Fax:715-261-8667
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2678152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38605800Medicaid
WI002639155OtherMEDICARE
WI38605800Medicaid