Provider Demographics
NPI:1740018928
Name:HEITKAMP, LAUREN (OD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:HEITKAMP
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 1:2580 MICHIGAN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-2492
Mailing Address - Country:US
Mailing Address - Phone:812-352-6600
Mailing Address - Fax:
Practice Address - Street 1:2580 MICHIGAN RD STE 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-2492
Practice Address - Country:US
Practice Address - Phone:812-352-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004532A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist