Provider Demographics
NPI:1134382104
Name:NASH, HEIDI J (OD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:J
Last Name:NASH
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 1:1830 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLE FOURCHE
Mailing Address - State:SD
Mailing Address - Zip Code:57717-2089
Mailing Address - Country:US
Mailing Address - Phone:605-228-3915
Mailing Address - Fax:
Practice Address - Street 1:1830 5TH AVE
Practice Address - Street 2:
Practice Address - City:BELLE FOURCHE
Practice Address - State:SD
Practice Address - Zip Code:57717-2089
Practice Address - Country:US
Practice Address - Phone:605-892-2020
Practice Address - Fax:605-892-6227
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD653152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist