Individual provider Active NPI

Heavin Bortz Maier, OD

  • Optometrist
  • Spokane, WA
National Provider Identifier
1861478869
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3911 Issued in WA
Practice address
412 E 30TH Ave
Spokane, WA 99203-2556
Phone
(509) 448-7300
Fax
(509) 448-7382
NPI assigned
Dec 21, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X ODP-100061 ID
Optometrist 152W00000X 2970AT OR
Optometrist 152W00000X 3911 WA Primary

Addresses

Primary practice location

412 E 30TH Ave
Spokane, WA 99203-2556

Mailing address

412 E 30TH Ave
Spokane, WA 99203-2556
Phone (509) 448-7300

Other identifiers 2

IdentifierTypeStateIssuer
0191247OtherWALABOR AND INDUSTRY
2029569MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041008000656 WA Practitioner - Optometry 5799744207 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eyes for Life P SGroup PAC ID 7214989755, 2 clinicians

Practice addresses (Care Compare)

412 E 30TH Ave
Spokane, WA 99203-2556
Phone (509) 448-7300

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery12

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ODP-100061IDMDOptometrist
2970ATORMDOptometrist
3911WAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eyes for Life PS Optometrist CurrentSince Oct 29, 2004 Accepting new patients

Locations

3022 E 57th Ave
Ste 11
Spokane, WA 99223
Phone (509) 448-7300

412 E 30th Ave
Spokane, WA 99203
Phone (509) 448-7300

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1861478869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 E 30TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992032556",
            "telephone_number": "509-448-7300",
            "fax_number": "509-448-7382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 E 30TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992032556",
            "telephone_number": "509-448-7300",
            "fax_number": "509-448-7382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAIER",
        "first_name": "HEAVIN",
        "middle_name": "BORTZ",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-21",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100061",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2970AT",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "3911",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRY",
            "identifier": "0191247",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2029569",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.