Provider Demographics
NPI:1194876987
Name:HEENE, JULIENNE HA (OD)
Entity type:Individual
Prefix:
First Name:JULIENNE
Middle Name:HA
Last Name:HEENE
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 1:224 BABETTE CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3811
Mailing Address - Country:US
Mailing Address - Phone:415-806-1537
Mailing Address - Fax:
Practice Address - Street 1:301 LENNON LN
Practice Address - Street 2:STE 201
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2483
Practice Address - Country:US
Practice Address - Phone:925-932-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12431T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0124310Medicare ID - Type Unspecified
CAU95948Medicare UPIN