Provider Demographics
NPI:1821174426
Name:HEINZ, BETHANY (OD)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:HEINZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:MCKITTRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:N1122 BARNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-8555
Mailing Address - Country:US
Mailing Address - Phone:920-840-7602
Mailing Address - Fax:
Practice Address - Street 1:1682 S KOELLER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-6166
Practice Address - Country:US
Practice Address - Phone:920-376-9626
Practice Address - Fax:920-376-9676
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2425152W00000X
WI3213-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COV01064Medicare UPIN