Provider Demographics
NPI:1164476784
Name:DOUCET, HEIDI BEAUMONT (OD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:BEAUMONT
Last Name:DOUCET
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 1:3729 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77632-4630
Mailing Address - Country:US
Mailing Address - Phone:409-883-5795
Mailing Address - Fax:409-883-9311
Practice Address - Street 1:3729 N 16TH ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77632-4630
Practice Address - Country:US
Practice Address - Phone:409-883-5795
Practice Address - Fax:409-883-9311
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6282TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00310YMedicare PIN