Basic Information
| Provider Information | |||||||||
| NPI: | 1992744437 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HECKER | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1507 WESTOVER TER | ||||||||
| Address2: | SUITE C | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362747771 | ||||||||
| FaxNumber: | 3362742024 | ||||||||
| Practice Location | |||||||||
| Address1: | 1507 WESTOVER TER | ||||||||
| Address2: | STE C | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362747771 | ||||||||
| FaxNumber: | 3362742024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 05/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 9700982 | NC | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 7901816 | 05 | NC | MEDICAID | 180033686 | 01 | NC | MEDICARE RAILROAD | OTHER |