Provider Demographics
NPI:1932157906
Name:HELLER, STUART WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:WILLIAM
Last Name:HELLER
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 1:391 CARMEN DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6033
Mailing Address - Country:US
Mailing Address - Phone:805-482-8849
Mailing Address - Fax:805-388-8516
Practice Address - Street 1:391 CARMEN DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6033
Practice Address - Country:US
Practice Address - Phone:805-482-8849
Practice Address - Fax:805-388-8516
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5401152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT09974Medicare UPIN