Provider Demographics
NPI:1568521318
Name:HEYMAN, PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:HEYMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:HEYMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:702 RUSSELL AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2606
Mailing Address - Country:US
Mailing Address - Phone:301-948-2060
Mailing Address - Fax:301-948-7687
Practice Address - Street 1:702 RUSSELL AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2606
Practice Address - Country:US
Practice Address - Phone:301-948-2060
Practice Address - Fax:301-948-7687
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTAO585152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG01878M01Medicare PIN
MDU11428Medicare UPIN