Provider Demographics
NPI:1962610840
Name:COTTER, HEATHER LOUISE (OD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LOUISE
Last Name:COTTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:COTTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:2008 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2431
Practice Address - Country:US
Practice Address - Phone:269-983-1303
Practice Address - Fax:269-983-1306
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004441152W00000X
IN18003540A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C97655081Medicare PIN
MI0733500Medicare PIN