Provider Demographics
NPI:1972629871
Name:HEASTON VISION CLINIC INC PS
Entity Type:Organization
Organization Name:HEASTON VISION CLINIC INC PS
Other - Org Name:HEASTON & THOMPSON VISION CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEASTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-943-3171
Mailing Address - Street 1:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-0610
Mailing Address - Country:US
Mailing Address - Phone:509-943-3171
Mailing Address - Fax:509-946-0905
Practice Address - Street 1:1321 AARON DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4678
Practice Address - Country:US
Practice Address - Phone:509-943-3171
Practice Address - Fax:509-946-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA410016629OtherRAILROAD MEDICARE
WA0344360001Medicare NSC
WA410016629OtherRAILROAD MEDICARE