Provider Demographics
NPI:1255429809
Name:HEINIG, GEORGE EDWARD (OD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EDWARD
Last Name:HEINIG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1931
Mailing Address - Country:US
Mailing Address - Phone:607-324-4480
Mailing Address - Fax:607-438-3211
Practice Address - Street 1:53 CENTER ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1931
Practice Address - Country:US
Practice Address - Phone:607-324-4480
Practice Address - Fax:607-438-3211
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006210-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02309295Medicaid
IA1237Medicare PIN
6215180001Medicare NSC