Provider Demographics
NPI:1942466081
Name:HEIDI SCHEFFERLY OD PLLC
Entity Type:Organization
Organization Name:HEIDI SCHEFFERLY OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHEFFERLY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-784-6928
Mailing Address - Street 1:306 W WASHINGTON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2141
Mailing Address - Country:US
Mailing Address - Phone:517-784-6928
Mailing Address - Fax:517-784-9633
Practice Address - Street 1:306 W WASHINGTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2141
Practice Address - Country:US
Practice Address - Phone:517-784-6928
Practice Address - Fax:517-784-9633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003898152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
900C812940OtherBLUE CROSS AND BLUE SHIELD OF MICHIGAN
900C812940OtherBLUE CROSS AND BLUE SHIELD OF MICHIGAN
OP61240Medicare PIN