Provider Demographics
NPI:1063563054
Name:SORENSEN, HEATHER WOOD (OD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:WOOD
Last Name:SORENSEN
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 1:6772 NEW ALBANY-CONDIT RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054
Mailing Address - Country:US
Mailing Address - Phone:614-933-0575
Mailing Address - Fax:614-933-0573
Practice Address - Street 1:6772 NEW ALBANY CONDIT RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054
Practice Address - Country:US
Practice Address - Phone:614-933-0575
Practice Address - Fax:614-933-0573
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4878152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU67610Medicare UPIN
SO0833223Medicare PIN