Provider Demographics
NPI:1699874693
Name:REILING, HEIDI ANN (OD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:ANN
Last Name:REILING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12621 ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1701
Mailing Address - Country:US
Mailing Address - Phone:913-814-7707
Mailing Address - Fax:913-814-7997
Practice Address - Street 1:12621 ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1701
Practice Address - Country:US
Practice Address - Phone:913-814-7707
Practice Address - Fax:913-814-7997
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS 1441152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT03193OtherMISSOURI LICENSE
KSKS 1441OtherKANSAS LICENSE
KSKS 1441OtherKANSAS LICENSE
KSJ767352Medicare PIN