Provider Demographics
NPI:1912052176
Name:HEFFINGTON OPTICAL COMPANY INC
Entity Type:Organization
Organization Name:HEFFINGTON OPTICAL COMPANY INC
Other - Org Name:OPTILAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEFFINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-869-3937
Mailing Address - Street 1:PO BOX 774
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-0774
Mailing Address - Country:US
Mailing Address - Phone:417-869-3937
Mailing Address - Fax:417-869-0281
Practice Address - Street 1:640 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-1016
Practice Address - Country:US
Practice Address - Phone:417-869-3937
Practice Address - Fax:417-869-0281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO322243700Medicaid
MO0607710001Medicare NSC
000007212Medicare PIN