Provider Demographics
NPI:1538285598
Name:HECKMAN, LISA K (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:K
Last Name:HECKMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:K
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3108 OLD WARSON RD
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-7346
Mailing Address - Country:US
Mailing Address - Phone:217-356-1789
Mailing Address - Fax:
Practice Address - Street 1:2000 N NEIL ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7808
Practice Address - Country:US
Practice Address - Phone:217-356-4619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008389152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist