Provider Demographics
NPI:1629283122
Name:CECILIA C HEIGES
Entity Type:Organization
Organization Name:CECILIA C HEIGES
Other - Org Name:VISION FITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:CARROLL
Authorized Official - Last Name:HEIGES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-482-3200
Mailing Address - Street 1:715 HILLGROVE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-5964
Mailing Address - Country:US
Mailing Address - Phone:708-482-3288
Mailing Address - Fax:
Practice Address - Street 1:715 HILLGROVE AVENUE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-5964
Practice Address - Country:US
Practice Address - Phone:708-482-3288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007699152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1684528OtherBCBS
IL5838702OtherAETNA
IL765550Medicare ID - Type Unspecified
ILT38759Medicare UPIN