Provider Demographics
NPI:1790778074
Name:HEIBY, JOHN C (OD, FAAO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:HEIBY
Suffix:
Gender:M
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 WOODROW AVE
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-1196
Mailing Address - Country:US
Mailing Address - Phone:740-695-2860
Mailing Address - Fax:740-695-1466
Practice Address - Street 1:156 WOODROW AVE
Practice Address - Street 2:SUITE # 1
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-1196
Practice Address - Country:US
Practice Address - Phone:740-695-2860
Practice Address - Fax:740-695-1466
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2873/T481152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH287306OtherWORKERS COMP.
OH0447562OtherMEDICARE MEDICAL CLAIMS PTAN
OHOH0337504Medicaid
OHOH0337504Medicaid
OH287306OtherWORKERS COMP.
OHHE0447562Medicare PIN
OH2367250001Medicare NSC