Provider Demographics
NPI:1194880617
Name:DEMOS, HEATHER MICHELLE (OD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MICHELLE
Last Name:DEMOS
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 1:310 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1648
Mailing Address - Country:US
Mailing Address - Phone:419-433-2630
Mailing Address - Fax:
Practice Address - Street 1:310 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839-1648
Practice Address - Country:US
Practice Address - Phone:419-433-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5022152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2276059Medicaid
OHU76171Medicare UPIN
OHDE0886031Medicare PIN