Provider Demographics
NPI:1578256038
Name:VALK, HEATHER (LDO)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:VALK
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-5614
Mailing Address - Country:US
Mailing Address - Phone:518-373-5756
Mailing Address - Fax:518-373-5759
Practice Address - Street 1:1549 ROUTE 9
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-5614
Practice Address - Country:US
Practice Address - Phone:518-373-5756
Practice Address - Fax:518-373-5759
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009920156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician