Provider Demographics
NPI:1902162126
Name:MICHELLE HEJNY
Entity Type:Organization
Organization Name:MICHELLE HEJNY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEJNY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:276-466-6173
Mailing Address - Street 1:500 GATE CITY HWY
Mailing Address - Street 2:SPACE 405
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-2372
Mailing Address - Country:US
Mailing Address - Phone:276-466-6173
Mailing Address - Fax:276-669-0570
Practice Address - Street 1:500 GATE CITY HWY
Practice Address - Street 2:SPACE 405
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-2372
Practice Address - Country:US
Practice Address - Phone:276-466-6173
Practice Address - Fax:276-669-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1144298456Medicaid
VA1144298456Medicaid