Provider Demographics
NPI:1861478869
Name:MAIER, HEAVIN BORTZ (OD)
Entity Type:Individual
Prefix:DR
First Name:HEAVIN
Middle Name:BORTZ
Last Name:MAIER
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 1:412 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2556
Mailing Address - Country:US
Mailing Address - Phone:509-448-7300
Mailing Address - Fax:509-448-7382
Practice Address - Street 1:412 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2556
Practice Address - Country:US
Practice Address - Phone:509-448-7300
Practice Address - Fax:509-448-7382
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100061152W00000X
OR2970AT152W00000X
WA3911152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0191247OtherLABOR AND INDUSTRY
WA2029569Medicaid
WAV01605Medicare UPIN
WA2029569Medicaid
WAP00199149Medicare Oscar/Certification
WA5569900001Medicare NSC