Provider Demographics
NPI:1477666287
Name:SOHRABI, HEATHER R (OD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:R
Last Name:SOHRABI
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 2014
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388
Mailing Address - Country:US
Mailing Address - Phone:931-455-5554
Mailing Address - Fax:931-455-3331
Practice Address - Street 1:921 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2313
Practice Address - Country:US
Practice Address - Phone:931-455-5554
Practice Address - Fax:931-455-3331
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2427152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN37727111Medicaid
TN37727111Medicaid
3727111Medicare ID - Type Unspecified