Provider Demographics
NPI:1316041403
Name:HEIDEN & HEIDEN PA
Entity Type:Organization
Organization Name:HEIDEN & HEIDEN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-922-5210
Mailing Address - Street 1:2019 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4509
Mailing Address - Country:US
Mailing Address - Phone:954-922-5210
Mailing Address - Fax:954-925-2190
Practice Address - Street 1:2019A HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4509
Practice Address - Country:US
Practice Address - Phone:954-922-5210
Practice Address - Fax:954-925-2190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084487000Medicaid
FL244075OtherAVMED
FL0522090001Medicare NSC
FL084487000Medicaid
FLAI030Medicare PIN