Provider Demographics
NPI:1336231737
Name:HEATH, PATRICK F (OD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:F
Last Name:HEATH
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 1:1140 13TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2204
Mailing Address - Country:US
Mailing Address - Phone:706-324-2073
Mailing Address - Fax:706-323-9435
Practice Address - Street 1:1140 13TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2204
Practice Address - Country:US
Practice Address - Phone:706-324-2073
Practice Address - Fax:706-323-9435
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001281152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009983630Medicaid
GA000472854JMedicaid
GA52048528003OtherBCBS OF GA
GA41ZCFDLMedicare ID - Type UnspecifiedMEDICARE
GA000472854JMedicaid