Provider Demographics
NPI:1225135593
Name:HEARD, PAUL EDWIN
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:EDWIN
Last Name:HEARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WEST RD
Mailing Address - Street 2:NAUSET OPTICAL
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653
Mailing Address - Country:US
Mailing Address - Phone:508-255-6394
Mailing Address - Fax:508-255-1696
Practice Address - Street 1:9 WEST RD
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653
Practice Address - Country:US
Practice Address - Phone:508-255-6394
Practice Address - Fax:508-255-1696
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1800X
MAMA1749156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0132780001Medicare NSC