Provider Demographics
NPI:1154311389
Name:HEFNER, CRYSTAL S (OD)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:S
Last Name:HEFNER
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:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-0446
Mailing Address - Country:US
Mailing Address - Phone:828-464-4136
Mailing Address - Fax:828-464-6243
Practice Address - Street 1:110 E A ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3343
Practice Address - Country:US
Practice Address - Phone:828-464-4136
Practice Address - Fax:828-464-6243
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0990152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09833OtherNC HEALTH CHOICE
NCNC0990OtherEYEMED VISION CARE
NC09833OtherBLUE CROSS BLUE SHIELD
NC10261OtherOPTICARE
NC22-42466OtherUNITED HEALTHCARE
NC89-09833OtherNC DIVISION OF THE BLIND
NC89-09833Medicaid
NC09833OtherBLUE CROSS BLUE SHIELD NC
NC271874OtherMAMSI
NC09833OtherNC STATE EMPLOYEES
NC89-09833OtherNC DIVISION OF THE BLIND
NC10261OtherOPTICARE
NC0124960001Medicare NSC