Provider Demographics
NPI:1972637460
Name:HERITAGE VISION CENTER, PC
Entity type:Organization
Organization Name:HERITAGE VISION CENTER, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DELPLANCHE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-629-5200
Mailing Address - Street 1:20 NW 185TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3507
Mailing Address - Country:US
Mailing Address - Phone:503-629-5200
Mailing Address - Fax:503-629-0419
Practice Address - Street 1:20 NW 185TH AVE
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-3507
Practice Address - Country:US
Practice Address - Phone:503-629-5200
Practice Address - Fax:503-629-0419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR154343Medicare PIN