Provider Demographics
NPI:1386034163
Name:HEIGHTS OPTOMETRY
Entity Type:Organization
Organization Name:HEIGHTS OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-431-5393
Mailing Address - Street 1:3404 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2428
Mailing Address - Country:US
Mailing Address - Phone:619-431-5393
Mailing Address - Fax:
Practice Address - Street 1:3404 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-2428
Practice Address - Country:US
Practice Address - Phone:619-431-5393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14770TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty