Provider Demographics
NPI:1295797447
Name:BEIERLE, HEATHER MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MARIE
Last Name:BEIERLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:LANTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2921 ERIE BLVD E
Mailing Address - Street 2:EMPIRE VISION CENTER, INC
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224
Mailing Address - Country:US
Mailing Address - Phone:315-445-7465
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:3900 VESTAL PKY E
Practice Address - Street 2:EMPIRE VISION CENTERS
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850
Practice Address - Country:US
Practice Address - Phone:607-771-1212
Practice Address - Fax:607-729-2605
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT0067171152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA4967Medicare PIN
U96399Medicare UPIN
NYRA4968Medicare PIN
NYAA0477Medicare PIN
NYRA4969Medicare PIN
NYDD6695Medicare ID - Type Unspecified