Provider Demographics
NPI:1225385644
Name:ENSLEY, HEIDI NICOLE (OD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:NICOLE
Last Name:ENSLEY
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 1:2508 EDGEMONT DR
Mailing Address - Street 2:STE 6
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-3854
Mailing Address - Country:US
Mailing Address - Phone:620-442-2577
Mailing Address - Fax:620-442-2578
Practice Address - Street 1:2508 EDGEMONT DR
Practice Address - Street 2:STE 6
Practice Address - City:ARKANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:67005-3854
Practice Address - Country:US
Practice Address - Phone:620-442-2577
Practice Address - Fax:620-442-2578
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1916152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist