Provider Demographics
NPI:1730238072
Name:HELDERMAN, WAYNE A (OPTOMETRIST)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:A
Last Name:HELDERMAN
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N MAYSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1315
Mailing Address - Country:US
Mailing Address - Phone:859-498-6001
Mailing Address - Fax:859-497-0222
Practice Address - Street 1:1 N MAYSVILLE ST
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1315
Practice Address - Country:US
Practice Address - Phone:859-498-6001
Practice Address - Fax:859-497-0222
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY762DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000382769OtherBCBS
KY77007623Medicaid
KY77007623Medicaid
KY000000382769OtherBCBS