Park, Heidi M
Park, Heidi M is an individual health care provider with primary practice located at 3701 S Main St , Elkhart IN 46517-3106. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Park, Heidi M can be contacted via phone (574) 875-8511.Contact Information
Primary practice address
3701 S Main St
Elkhart IN 46517-3106
Phone: (574) 875-8511
Fax: (574) 875-8763
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 18003405 A | Indiana |
Profile Details
| NPI number | 1710902721 |
|---|---|
| LBN Legal business name | Park, Heidi M |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 12th, 2006 |
| Last updated | Feb 24th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1710902721 | NPPES |
| Indiana | Other | 180003405A | OPTOMETRIC LICENSE |
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