Basic Information
| Provider Information | |||||||||
| NPI: | 1447319454 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HECKER OPHTHALMOLOGY PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1507 WESTOVER TER STE C | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362747771 | ||||||||
| FaxNumber: | 3362742024 | ||||||||
| Practice Location | |||||||||
| Address1: | 1507 WESTOVER TER STE C | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362747771 | ||||||||
| FaxNumber: | 3362742024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | HECKER | ||||||||
| AuthorizedOfficialFirstName: | KATHRYN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3362747771 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 9700982 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | CN8607 | 01 | NC | MEDICARE RAILROAD | OTHER | 01816 | 01 | NC | BCBS | OTHER | 891069A | 05 | NC | MEDICAID | 18146 | 01 | NC | PARTNERS MEDICARE CHOICE | OTHER |