Provider Demographics
NPI:1407869092
Name:ROBBEN, HEATHER ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ANN
Last Name:ROBBEN
Suffix:
Gender:F
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:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:WAKEENEY
Mailing Address - State:KS
Mailing Address - Zip Code:67672-0458
Mailing Address - Country:US
Mailing Address - Phone:785-743-5522
Mailing Address - Fax:785-743-5577
Practice Address - Street 1:310 N 6TH ST
Practice Address - Street 2:
Practice Address - City:WAKEENEY
Practice Address - State:KS
Practice Address - Zip Code:67672-1805
Practice Address - Country:US
Practice Address - Phone:785-743-5522
Practice Address - Fax:785-743-5577
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2022-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1751152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00436065OtherRR MCR
KS060539001OtherDMERC
KS410032265OtherRR MCR
KS060539001OtherDMERC
KS410032265OtherRR MCR
KSV10690Medicare UPIN
KS200402860AMedicaid
KS6152030001Medicare NSC
KS651156Medicare PIN