Provider Demographics
NPI:1235190026
Name:HEYD, JEFFREY ARDEN (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ARDEN
Last Name:HEYD
Suffix:
Gender:M
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:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67871-0108
Mailing Address - Country:US
Mailing Address - Phone:620-872-2020
Mailing Address - Fax:
Practice Address - Street 1:106 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:KS
Practice Address - Zip Code:67871-1108
Practice Address - Country:US
Practice Address - Phone:620-872-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1451-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100363590AMedicaid
KSU57736Medicare UPIN
KS1059060001Medicare NSC
KS100363590AMedicaid