Provider Demographics
NPI:1962750828
Name:O'MARA, HEATHER HILDEBRAND (OD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:HILDEBRAND
Last Name:O'MARA
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 1:415 TIMBER CUT LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-9534
Mailing Address - Country:US
Mailing Address - Phone:919-740-3256
Mailing Address - Fax:
Practice Address - Street 1:11312 US 15 501 N
Practice Address - Street 2:STE 304
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-6375
Practice Address - Country:US
Practice Address - Phone:919-933-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2281152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5921838Medicaid