Provider Demographics
NPI:1457382822
Name:HEISLER, HOWARD J (OD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:J
Last Name:HEISLER
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:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:REDLAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56671-0497
Mailing Address - Country:US
Mailing Address - Phone:218-679-3912
Mailing Address - Fax:218-679-0181
Practice Address - Street 1:PHS INDIAN HOSPITAL
Practice Address - Street 2:HIGHWAY 1
Practice Address - City:RED LAKE
Practice Address - State:MN
Practice Address - Zip Code:56671-0497
Practice Address - Country:US
Practice Address - Phone:218-679-3912
Practice Address - Fax:218-679-0181
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2246152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN34G01HEOtherBC/BS OF MN
MN34G01HEOtherBC/BS OF MN
MNU46910Medicare UPIN
MN240206Medicare Oscar/Certification