Provider Demographics
NPI:1932234341
Name:HEFFINGTON, MARK R (ABOC-FNAO)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:R
Last Name:HEFFINGTON
Suffix:
Gender:M
Credentials:ABOC-FNAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1550 E BATTLEFIELD ST STE J
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-3700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1550 E BATTLEFIELD ST STE J
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3700
Practice Address - Country:US
Practice Address - Phone:417-882-3937
Practice Address - Fax:417-887-5166
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12844156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician