Provider Demographics
NPI:1891949830
Name:FLYG, HEIDI MARIE (OD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:MARIE
Last Name:FLYG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:MARIE
Other - Last Name:WILGENBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3801 MIRANDA AVENUE
Mailing Address - Street 2:VA PALO ALTO HEALTH CARE SYSTEM (640/112)
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304
Mailing Address - Country:US
Mailing Address - Phone:650-493-5000
Mailing Address - Fax:650-496-2529
Practice Address - Street 1:3801 MIRANDA AVENUE
Practice Address - Street 2:VA PALO ALTO HEALTH CARE SYSTEM (640/112)
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:650-496-2529
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13437152WL0500X, 152W00000X
CO2754152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation