Provider Demographics
NPI:1144298456
Name:HEJNY, MICHELLE (OD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HEJNY
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 1:2829 E OAKLAND AVE
Mailing Address - Street 2:#1
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1347
Mailing Address - Country:US
Mailing Address - Phone:423-283-4590
Mailing Address - Fax:423-283-0867
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
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0009236295Medicaid
VA0009236295Medicaid