Provider Demographics
NPI:1124139787
Name:HECK SACOPULOS, DARLA (OD)
Entity type:Individual
Prefix:
First Name:DARLA
Middle Name:
Last Name:HECK SACOPULOS
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 1:325 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-2542
Mailing Address - Country:US
Mailing Address - Phone:812-443-0060
Mailing Address - Fax:812-446-5061
Practice Address - Street 1:325 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2542
Practice Address - Country:US
Practice Address - Phone:812-443-0060
Practice Address - Fax:812-446-5061
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002508A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5460840001OtherDMERC
IN18002508BOtherINDIANA OLDPAC LIC.
IN227140Medicare ID - Type Unspecified
IN5460840001OtherDMERC