Provider Demographics
NPI:1801989009
Name:HEITMEIER, DAVID R (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:HEITMEIER
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 1:3501 HOLIDAY DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-8250
Mailing Address - Country:US
Mailing Address - Phone:504-368-7081
Mailing Address - Fax:504-207-7031
Practice Address - Street 1:3501 HOLIDAY DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-8250
Practice Address - Country:US
Practice Address - Phone:504-368-7081
Practice Address - Fax:504-207-7031
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1029010T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1371262Medicaid
T19538Medicare UPIN
LA48324C652Medicare ID - Type Unspecified