Provider Demographics
NPI:1427606508
Name:NENOV, HEATHER (OD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:NENOV
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3200 N SEPULVEDA BLVD
Mailing Address - Street 2:STE E4
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2469
Mailing Address - Country:US
Mailing Address - Phone:310-795-9636
Mailing Address - Fax:
Practice Address - Street 1:3200 N SEPULVEDA BLVD STE E4
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2469
Practice Address - Country:US
Practice Address - Phone:310-546-5568
Practice Address - Fax:310-546-5421
Is Sole Proprietor?:No
Enumeration Date:2019-08-31
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34386TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist