Provider Demographics
NPI:1659357986
Name:HEEDEN, LOUIS F (OD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:F
Last Name:HEEDEN
Suffix:
Gender:M
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:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-1332
Mailing Address - Fax:336-716-3202
Practice Address - Street 1:631 COLISEUM DR
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5310
Practice Address - Country:US
Practice Address - Phone:336-723-1041
Practice Address - Fax:336-716-7994
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0838152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909371Medicaid
T64728Medicare UPIN
NC8909371Medicaid