Provider Demographics
NPI:1568610384
Name:HEINTZELMAN, SAYGE M (OD)
Entity Type:Individual
Prefix:DR
First Name:SAYGE
Middle Name:M
Last Name:HEINTZELMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61896
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98666-1896
Mailing Address - Country:US
Mailing Address - Phone:360-696-4691
Mailing Address - Fax:360-696-2078
Practice Address - Street 1:3200 MAIN ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2753
Practice Address - Country:US
Practice Address - Phone:360-696-4691
Practice Address - Fax:360-696-2078
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60032052152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8885863OtherMEDICARE