Provider Demographics
NPI:1760480297
Name:HEFFRON, JAMISON J (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMISON
Middle Name:J
Last Name:HEFFRON
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 1:507 S L ROGERS WELLS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-1047
Mailing Address - Country:US
Mailing Address - Phone:270-629-2015
Mailing Address - Fax:270-629-2016
Practice Address - Street 1:507 S L ROGERS WELLS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-1047
Practice Address - Country:US
Practice Address - Phone:270-629-2015
Practice Address - Fax:270-629-2016
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1319DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL410049287OtherRAILROAD MEDICARE
000000199532OtherBCBS
KY77013191Medicaid
AL410049287OtherRAILROAD MEDICARE
9368102Medicare ID - Type Unspecified