Basic Information
| Provider Information | |||||||||
| NPI: | 1316026313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEIMLICH | ||||||||
| FirstName: | MARVIN | ||||||||
| MiddleName: | HAROLD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 713 GREENWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | WILMETTE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600911747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472562645 | ||||||||
| FaxNumber: | 8475411184 | ||||||||
| Practice Location | |||||||||
| Address1: | 307 S MILWAUKEE AVE | ||||||||
| Address2: | LIBERTYVILLE VISION CENTER | ||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475411184 | ||||||||
| FaxNumber: | 8475411194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | IL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.