Provider Demographics
NPI:1154406478
Name:WOOTEN, HEATHER HANSON (OD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:HANSON
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:DAWN
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-7879
Mailing Address - Country:US
Mailing Address - Phone:785-823-8844
Mailing Address - Fax:785-823-8864
Practice Address - Street 1:2900 S 9TH ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-7879
Practice Address - Country:US
Practice Address - Phone:785-823-8844
Practice Address - Fax:785-823-8864
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1717152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V07538Medicare UPIN
651079Medicare ID - Type Unspecified
651080Medicare ID - Type Unspecified