NPIMap

Individual provider Active NPI

Robert A Heacock, O.D.

  • Optometrist
  • Heath, OH
National Provider Identifier
1972590669
Registry record updated Feb 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3072 T479 Issued in OH
Practice address
604 S 30TH St
Heath, OH 43056-1213
Phone
(740) 522-8444
Fax
(740) 522-6493
NPI assigned
Sep 29, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3072 T479 OH Primary

Addresses

Primary practice location

604 S 30TH St
Heath, OH 43056-1213

Mailing address

604 S 30TH St
Heath, OH 43056-1213
Phone (740) 522-8444

Other identifiers 1

IdentifierTypeStateIssuer
0567104MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3072 T479OHMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Surgery Consultants Inc. Past Accepting new patients
Indian Mound Eye Clinic Inc Optometrist PastSince Jun 1, 1990 Accepting new patients

Organizations & group practices 2

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": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202342400000",
    "number": "1972590669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 S 30TH ST",
            "city": "HEATH",
            "state": "OH",
            "postal_code": "430561213",
            "telephone_number": "740-522-8444",
            "fax_number": "740-522-6493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 S 30TH ST",
            "city": "HEATH",
            "state": "OH",
            "postal_code": "430561213",
            "telephone_number": "740-522-8444",
            "fax_number": "740-522-6493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEACOCK",
        "first_name": "ROBERT",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-29",
        "last_updated": "2008-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "3072  T479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0567104",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Heath, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.