Provider Demographics
NPI:1851485064
Name:ECKHART, HEATH KELLY (OD)
Entity Type:Individual
Prefix:DR
First Name:HEATH
Middle Name:KELLY
Last Name:ECKHART
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 1:16009 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323-2595
Mailing Address - Country:US
Mailing Address - Phone:515-724-2242
Mailing Address - Fax:
Practice Address - Street 1:300 IOWA SPEEDWAY DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-9484
Practice Address - Country:US
Practice Address - Phone:515-724-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02204152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU90966Medicare UPIN