Provider Demographics
NPI:1205211232
Name:PAULUS, HEATHER L (OD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:PAULUS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:SLATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1657 HOLLAND RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1661
Mailing Address - Country:US
Mailing Address - Phone:419-891-1023
Mailing Address - Fax:419-891-1138
Practice Address - Street 1:1657 HOLLAND RD
Practice Address - Street 2:SUITE D
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1661
Practice Address - Country:US
Practice Address - Phone:419-891-1023
Practice Address - Fax:419-891-1138
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-20
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT 6399152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOPT 6399OtherOHIO OPTOMETRY LICENSE NUMBER
OHT3316OtherTHERAPEUTIC CERTIFICATE NUMBER