Provider Demographics
NPI:1275793291
Name:RICHARD HEGGELAND, OD, PC
Entity Type:Organization
Organization Name:RICHARD HEGGELAND, OD, PC
Other - Org Name:OPTICAL INSIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEGGELAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-271-0611
Mailing Address - Street 1:1000 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:# 14
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6737
Mailing Address - Country:US
Mailing Address - Phone:770-271-0611
Mailing Address - Fax:770-271-5525
Practice Address - Street 1:1000 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:# 14
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6737
Practice Address - Country:US
Practice Address - Phone:770-271-0611
Practice Address - Fax:770-271-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA756T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty