Provider Demographics
NPI:1831681881
Name:HEINRICH, DONNA TRAUSCHT (OD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:TRAUSCHT
Last Name:HEINRICH
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 1:26192 VIA ESTELITA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3036
Mailing Address - Country:US
Mailing Address - Phone:949-233-9124
Mailing Address - Fax:949-661-4634
Practice Address - Street 1:32241 CAMINO CAPISTRANO STE A101
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3708
Practice Address - Country:US
Practice Address - Phone:949-661-3669
Practice Address - Fax:949-661-4634
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8883-TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1003003096Medicaid