Basic Information
| Provider Information | |||||||||
| NPI: | 1871901231 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUTTON | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | THIGPEN | ||||||||
| OtherFirstName: | HEATHER | ||||||||
| OtherMiddleName: | NICOLE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 110 COLLEGE ST STE B | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356112714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562332393 | ||||||||
| FaxNumber: | 2562332309 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 COLLEGE ST STE B | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356112714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562332393 | ||||||||
| FaxNumber: | 2562332309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2014 | ||||||||
| LastUpdateDate: | 07/30/2014 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | S-D21-TA-986 | AL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.