Provider Demographics
NPI:1609920289
Name:HERITAGE VISION CENTER, INC.
Entity Type:Organization
Organization Name:HERITAGE VISION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BACK OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-978-2020
Mailing Address - Street 1:2427 HERITAGE VLG
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2699
Mailing Address - Country:US
Mailing Address - Phone:770-978-2020
Mailing Address - Fax:770-978-1750
Practice Address - Street 1:2427 HERITAGE VLG
Practice Address - Street 2:SUITE 4
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2699
Practice Address - Country:US
Practice Address - Phone:770-978-2020
Practice Address - Fax:770-978-1750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001935152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000922842BMedicaid
GA000922842BMedicaid