Provider Demographics
NPI:1255718003
Name:HEIER, JAYSON (OD)
Entity type:Individual
Prefix:DR
First Name:JAYSON
Middle Name:
Last Name:HEIER
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 1:29 E TOWNE MALL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3711
Mailing Address - Country:US
Mailing Address - Phone:608-246-0308
Mailing Address - Fax:608-246-0423
Practice Address - Street 1:29 E TOWNE MALL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3711
Practice Address - Country:US
Practice Address - Phone:608-246-0308
Practice Address - Fax:608-246-0423
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3406152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI598655Medicaid
WI1F571ZMedicare PIN