Provider Demographics
NPI:1902456296
Name:HEITMEIER, LEAH ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:ELIZABETH
Last Name:HEITMEIER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 WESTBANK EXPY STE 510
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-3615
Mailing Address - Country:US
Mailing Address - Phone:504-366-9435
Mailing Address - Fax:504-368-5585
Practice Address - Street 1:91 WESTBANK EXPY STE 510
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-3615
Practice Address - Country:US
Practice Address - Phone:504-366-9435
Practice Address - Fax:504-368-5585
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3022152W00000X
LA1909-845AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1909-845ATOtherLOUISIANA OPTOMETRY LICENSE
OK3022OtherOKLAHOMA OPTOMETRY LICENSE