Provider Demographics
NPI:1548327455
Name:HEASTON, KAREN MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MARIE
Last Name:HEASTON
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 1:1321 AARON DR
Mailing Address - Street 2:P.O. BOX 610
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4678
Mailing Address - Country:US
Mailing Address - Phone:509-943-3171
Mailing Address - Fax:
Practice Address - Street 1:1321 AARON DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4678
Practice Address - Country:US
Practice Address - Phone:509-943-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD4077152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0228350OtherWA LABOR AND INDUSTRY
WA8868183OtherPTAN
1548327455Medicare UPIN