Provider Demographics
NPI:1447383021
Name:HERITAGE VISION CENTER INC
Entity Type:Organization
Organization Name:HERITAGE VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-264-1701
Mailing Address - Street 1:6096 U S HIGHWAY 98
Mailing Address - Street 2:STE. 1
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8885
Mailing Address - Country:US
Mailing Address - Phone:601-264-1701
Mailing Address - Fax:601-268-9109
Practice Address - Street 1:6096 U S HIGHWAY 98
Practice Address - Street 2:STE. 1
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8885
Practice Address - Country:US
Practice Address - Phone:601-264-1701
Practice Address - Fax:601-268-9109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Multi-Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty
No156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880044Medicaid
MS0691010001Medicare ID - Type Unspecified