Provider Demographics
NPI:1659605848
Name:HEATON, ALISHA M (OD)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:M
Last Name:HEATON
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 1:16010 E INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1813
Mailing Address - Country:US
Mailing Address - Phone:509-928-8040
Mailing Address - Fax:509-928-0784
Practice Address - Street 1:1901 E SELTICE WAY
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9647
Practice Address - Country:US
Practice Address - Phone:208-667-2531
Practice Address - Fax:208-765-9385
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT809152W00000X
IDODP-100199152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1659605848Medicaid
WA2071233Medicaid