Provider Demographics
NPI:1346689361
Name:PORTER, HEATHER MARIE (OD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:PORTER
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:3620 W FIRST STREET
Mailing Address - Street 2:SUITE 60
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-1569
Mailing Address - Country:US
Mailing Address - Phone:469-715-0775
Mailing Address - Fax:469-715-0717
Practice Address - Street 1:3620 W FIRST STREET
Practice Address - Street 2:SUITE 60
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078
Practice Address - Country:US
Practice Address - Phone:077-546-9715
Practice Address - Fax:071-746-9715
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2023-05-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX8176T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist