Provider Demographics
NPI:1811982515
Name:HEDDINGHAUS, SHAWNA L (OD)
Entity type:Individual
Prefix:DR
First Name:SHAWNA
Middle Name:L
Last Name:HEDDINGHAUS
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 1:600 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BENLD
Mailing Address - State:IL
Mailing Address - Zip Code:62009-1446
Mailing Address - Country:US
Mailing Address - Phone:217-835-7724
Mailing Address - Fax:217-835-7611
Practice Address - Street 1:600 S 8TH ST
Practice Address - Street 2:
Practice Address - City:BENLD
Practice Address - State:IL
Practice Address - Zip Code:62009-1446
Practice Address - Country:US
Practice Address - Phone:217-835-7724
Practice Address - Fax:217-835-7611
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009181152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
419640OtherHEALTHLINK
5275510001OtherDMERC
ILK37256OtherMEDICARE AT EVC
P00184209OtherPIN MEDICARE RR
IL05927400OtherBCBS
DC6896OtherMEDICARE RR
IL05927400OtherBCBS
P00184209OtherPIN MEDICARE RR