Provider Demographics
NPI:1306101514
Name:LORI A HEYLER OD LLC
Entity type:Organization
Organization Name:LORI A HEYLER OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HEYLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:508-854-0595
Mailing Address - Street 1:67 W BOYLSTON ST UNIT 11
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-1752
Mailing Address - Country:US
Mailing Address - Phone:508-854-0595
Mailing Address - Fax:508-854-0496
Practice Address - Street 1:67 W BOYLSTON ST UNIT 11
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-1752
Practice Address - Country:US
Practice Address - Phone:508-854-0595
Practice Address - Fax:508-854-0496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4809152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0029194Medicare PIN