Provider Demographics
NPI:1780935007
Name:HEINER, DARREN WILLIAMS (OD)
Entity type:Individual
Prefix:DR
First Name:DARREN
Middle Name:WILLIAMS
Last Name:HEINER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4207 CLOCK TOWER AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-5236
Mailing Address - Country:US
Mailing Address - Phone:208-510-5150
Mailing Address - Fax:208-510-6060
Practice Address - Street 1:4207 CLOCK TOWER AVE STE 102
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-5236
Practice Address - Country:US
Practice Address - Phone:208-510-5150
Practice Address - Fax:208-510-6060
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100276152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist