Provider Demographics
NPI:1710956990
Name:HECK, CHARLES D (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:HECK
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 1:1705 FREDERICA ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-4814
Mailing Address - Country:US
Mailing Address - Phone:270-683-2121
Mailing Address - Fax:270-683-3167
Practice Address - Street 1:1705 FREDERICA ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-4814
Practice Address - Country:US
Practice Address - Phone:270-683-2121
Practice Address - Fax:270-683-3167
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY945DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK040190OtherMEDICARE PTAN
KY77904019Medicaid
KYP01058277OtherRAILROAD MEDICARE
KY000000354038OtherANTHEM BCBS NUMBER
KY77009454Medicaid
KYK040190OtherMEDICARE PTAN
KY000000354038OtherANTHEM BCBS NUMBER
KY77009454Medicaid