Provider Demographics
NPI:1518963842
Name:HEISEY, LINDA L (OD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:HEISEY
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 1:1 GRANITE POINT DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1986
Mailing Address - Country:US
Mailing Address - Phone:610-378-1344
Mailing Address - Fax:610-378-5169
Practice Address - Street 1:1 GRANITE POINT DR
Practice Address - Street 2:STE 100
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1986
Practice Address - Country:US
Practice Address - Phone:610-378-1344
Practice Address - Fax:610-378-5159
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000735152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA410032353OtherRAILROAD MEDICARE
PA071268Medicare ID - Type UnspecifiedOPTOMETRY
PAT28153Medicare UPIN