Provider Demographics
NPI:1720154115
Name:CALLADINE, HEIDI FIKE (OD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:FIKE
Last Name:CALLADINE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:ELIZABETH
Other - Last Name:FIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:508 FLETCHER DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2183
Mailing Address - Country:US
Mailing Address - Phone:540-216-7632
Mailing Address - Fax:540-216-7636
Practice Address - Street 1:508 FLETCHER DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2183
Practice Address - Country:US
Practice Address - Phone:540-216-7632
Practice Address - Fax:540-216-7636
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001691152W00000X
MDTA2024152W00000X
NYTUV007377152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA104539Medicare PIN