Provider Demographics
NPI:1790817559
Name:LECLAIRE, HEATHER (OD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:LECLAIRE
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 1:411 E MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4510
Mailing Address - Country:US
Mailing Address - Phone:360-647-2020
Mailing Address - Fax:360-752-1771
Practice Address - Street 1:411 E MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4510
Practice Address - Country:US
Practice Address - Phone:360-647-2020
Practice Address - Fax:360-752-1771
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3024152W00000X
WA3916152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist