Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 27OA00597900 | NJ |
NPI | 1003806761 |
---|---|
Provider Name | Mrs. Meggan Clair Heinz |
First Address | Monroe Township, NJ 08831 |
Second Address | Monroe Township, NJ 08831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 14/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0085928 | (05) | NJ |
V07366 | (02) | NJ |