Provider Demographics
NPI:1164929022
Name:VAN LAW, HEATHER (OD, MS, FAAO)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:VAN LAW
Suffix:
Gender:F
Credentials:OD, MS, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9205 N UNION BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7840
Mailing Address - Country:US
Mailing Address - Phone:719-282-0400
Mailing Address - Fax:719-282-1004
Practice Address - Street 1:9205 N UNION BLVD STE 110
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7840
Practice Address - Country:US
Practice Address - Phone:719-282-0400
Practice Address - Fax:719-282-1004
Is Sole Proprietor?:No
Enumeration Date:2018-04-08
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003386152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist