Provider Demographics
NPI:1518067693
Name:HEIGES, CECILIA CARROLL (OD)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:CARROLL
Last Name:HEIGES
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 1:715 W HILLGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-5964
Mailing Address - Country:US
Mailing Address - Phone:708-482-3200
Mailing Address - Fax:708-482-3288
Practice Address - Street 1:715 W HILLGROVE AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-5964
Practice Address - Country:US
Practice Address - Phone:708-482-3200
Practice Address - Fax:708-482-3288
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007699152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001684528OtherBCBS
ILT38759Medicare UPIN
IL765550Medicare ID - Type UnspecifiedMEDICARE