Provider Demographics
NPI:1255326864
Name:HEAP, STEVEN PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PAUL
Last Name:HEAP
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 1:39 E 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:EAGAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85925-9664
Mailing Address - Country:US
Mailing Address - Phone:928-333-4396
Mailing Address - Fax:928-333-5050
Practice Address - Street 1:39 E 1ST STREET
Practice Address - Street 2:
Practice Address - City:EAGAR
Practice Address - State:AZ
Practice Address - Zip Code:85925-9664
Practice Address - Country:US
Practice Address - Phone:928-333-4396
Practice Address - Fax:928-333-5050
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ523152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ036071Medicaid
AZ5219420001OtherDMERC SUPPLIER
AZ036071Medicaid