Provider Demographics
NPI:1649593393
Name:BROOKS, HEATHER M (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:BROOKS
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-1222
Mailing Address - Country:US
Mailing Address - Phone:518-822-9060
Mailing Address - Fax:518-822-9062
Practice Address - Street 1:389 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1222
Practice Address - Country:US
Practice Address - Phone:518-822-9060
Practice Address - Fax:518-822-9062
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008662-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician