Basic Information
| Provider Information | |||||||||
| NPI: | 1003806761 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEINZ | ||||||||
| FirstName: | MEGGAN | ||||||||
| MiddleName: | CLAIR | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 FEDERAL ROAD | ||||||||
| Address2: | |||||||||
| City: | MONROE TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322133894 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 155 FEDERAL ROAD | ||||||||
| Address2: | |||||||||
| City: | MONROE TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322133894 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2005 | ||||||||
| LastUpdateDate: | 11/14/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 27OA00597900 | NJ | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 0085928 | 05 | NJ | MEDICAID |