Provider Demographics
NPI:1841276144
Name:HEIL, MICHAEL E (OD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:HEIL
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 1:2505 S 38TH ST
Mailing Address - Street 2:SUITE A-108
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7375
Mailing Address - Country:US
Mailing Address - Phone:253-472-1188
Mailing Address - Fax:253-472-3594
Practice Address - Street 1:2505 S 38TH ST
Practice Address - Street 2:SUITE A-108
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7375
Practice Address - Country:US
Practice Address - Phone:253-472-1188
Practice Address - Fax:253-472-3594
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001426TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8889818OtherMEDICARE PTAN SOUTH CENTER
WA2003416Medicaid
WAG8889817OtherMEDACARE PIN SOUTH CENTER
WAGAB16987OtherMEDICARE PTAN TACOMA
WAT02769Medicare UPIN
WAGAB16987OtherMEDICARE PTAN TACOMA