Provider Demographics
NPI:1336156553
Name:WEBSTER, HEATHER MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MARIE
Last Name:WEBSTER
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 1:479 N MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:KAHOKA
Mailing Address - State:MO
Mailing Address - Zip Code:63445-1098
Mailing Address - Country:US
Mailing Address - Phone:573-874-3937
Mailing Address - Fax:
Practice Address - Street 1:30 E SOUTHAMPTON DR UNIT 109
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6136
Practice Address - Country:US
Practice Address - Phone:573-874-3937
Practice Address - Fax:573-874-4180
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006021777152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist