Provider Demographics
NPI:1154488427
Name:HESKETT, TED WAYNE JR (RDO)
Entity type:Individual
Prefix:MR
First Name:TED
Middle Name:WAYNE
Last Name:HESKETT
Suffix:JR
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 SUTTER ST STE 222
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-1111
Mailing Address - Country:US
Mailing Address - Phone:415-982-8272
Mailing Address - Fax:415-982-8664
Practice Address - Street 1:500 SUTTER ST STE 222
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1111
Practice Address - Country:US
Practice Address - Phone:415-982-8272
Practice Address - Fax:415-982-8664
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACL 70156FC0800X
CAD-602156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0166360001Medicare ID - Type Unspecified