Provider Demographics
NPI:1992796783
Name:TRAPHEAGEN, HEATHER L (OD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L
Last Name:TRAPHEAGEN
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 1:217 DEL PRADO BLVD S STE 101
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1743
Mailing Address - Country:US
Mailing Address - Phone:239-573-3937
Mailing Address - Fax:239-573-0263
Practice Address - Street 1:217 DEL PRADO BLVD S STE 101
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1743
Practice Address - Country:US
Practice Address - Phone:239-573-3937
Practice Address - Fax:239-573-0263
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3636152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620678600Medicaid
FLU87008Medicare UPIN
FL620678600Medicaid