Basic Information
| Provider Information | |||||||||
| NPI: | 1962896373 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR. HEATHER SANNER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 353 N ACADEMY BLVD | ||||||||
| Address2: | INSIDE EYEGLASS WORLD | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809096605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195743300 | ||||||||
| FaxNumber: | 7195743322 | ||||||||
| Practice Location | |||||||||
| Address1: | 353 N ACADEMY BLVD | ||||||||
| Address2: | INSIDE EYEGLASS WORLD | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809096605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195743300 | ||||||||
| FaxNumber: | 7195743322 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2015 | ||||||||
| LastUpdateDate: | 03/24/2015 | ||||||||
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| AuthorizedOfficialLastName: | SANNER | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7195107219 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2546 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.