Provider Demographics
NPI:1598128019
Name:VAN HEEL, AMY RAE (OD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:RAE
Last Name:VAN HEEL
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 1:2445 NE CUMULUS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-8862
Mailing Address - Country:US
Mailing Address - Phone:503-472-4688
Mailing Address - Fax:
Practice Address - Street 1:2445 NE CUMULUS AVE STE A
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8862
Practice Address - Country:US
Practice Address - Phone:503-472-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4291ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist