Provider Demographics
NPI:1063403632
Name:SCHEFFERLY, HEIDI LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:LYNN
Last Name:SCHEFFERLY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4877 W TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:RIVES JUNCTION
Mailing Address - State:MI
Mailing Address - Zip Code:49277-9639
Mailing Address - Country:US
Mailing Address - Phone:517-589-5062
Mailing Address - Fax:
Practice Address - Street 1:306 W WASHINGTON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2169
Practice Address - Country:US
Practice Address - Phone:517-783-6928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003898152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI410045602OtherPALMETTO GBA RR MEDICARE
MIBCBS OF MICHIGANOther900C865230
MI1312340001OtherDMERC
MIVCM-0149OtherM-CARE
MI22-20000OtherPHP OF SOUTHERN MICHIGAN
MIBCBS OF MICHIGANOther900C865230
MI1312340001OtherDMERC