Provider Demographics
NPI:1700311040
Name:HECK, CHELSEA ELYSE (OD)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ELYSE
Last Name:HECK
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 1:415 N CAUSEWAY
Mailing Address - Street 2:
Mailing Address - City:NEW SMRYNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169
Mailing Address - Country:US
Mailing Address - Phone:386-427-4143
Mailing Address - Fax:386-427-0711
Practice Address - Street 1:415 N CAUSEWAY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-5235
Practice Address - Country:US
Practice Address - Phone:386-427-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5443152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty