Provider Demographics
NPI:1881003325
Name:HEADRICK, CASIE MAE (OD)
Entity Type:Individual
Prefix:
First Name:CASIE
Middle Name:MAE
Last Name:HEADRICK
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 1:8131 E COLORADO AVE
Mailing Address - Street 2:APT J102
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-8014
Mailing Address - Country:US
Mailing Address - Phone:501-620-0876
Mailing Address - Fax:
Practice Address - Street 1:8131 E COLORADO AVE
Practice Address - Street 2:APT J102
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-8014
Practice Address - Country:US
Practice Address - Phone:501-620-0876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003090152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist