Basic Information
| Provider Information | |||||||||
| NPI: | 1578864310 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DR. PAMELA R. HEIPLE P.A. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PAMELA HEIPLE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 W NEW HAVEN AVE | ||||||||
| Address2: | C/O JCPENNEY OPTICAL | ||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329043919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217278807 | ||||||||
| FaxNumber: | 3216761541 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 W NEW HAVEN AVE | ||||||||
| Address2: | C/O JCPENNEY OPTICAL | ||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329043919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217278807 | ||||||||
| FaxNumber: | 3216761541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2010 | ||||||||
| LastUpdateDate: | 02/18/2014 | ||||||||
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| AuthorizedOfficialLastName: | HEIPLE | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
| AuthorizedOfficialMiddleName: | RAE | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 3215080793 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC002725 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.