Provider Demographics
NPI:1659825339
Name:DEMARCO, HEATHER DANIELLE WHYTE (OD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DANIELLE WHYTE
Last Name:DEMARCO
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 1:1695 KERNERSVILLE MEDICAL PARKWAY
Mailing Address - Street 2:OUTPATIENT EYE CLINIC
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284
Mailing Address - Country:US
Mailing Address - Phone:336-515-5000
Mailing Address - Fax:
Practice Address - Street 1:1695 KERNERSVILLE MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7159
Practice Address - Country:US
Practice Address - Phone:336-515-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003222152W00000X
NC2503152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA13874479OtherCAQH NUMBER