Provider Demographics
NPI:1053390385
Name:HEILMAN, NATHAN PETER (OD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:PETER
Last Name:HEILMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 JEFFERSON RD
Mailing Address - Street 2:STE A
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-3258
Mailing Address - Country:US
Mailing Address - Phone:507-645-9202
Mailing Address - Fax:507-645-9203
Practice Address - Street 1:2019 JEFFERSON RD STE A
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-3258
Practice Address - Country:US
Practice Address - Phone:507-645-9202
Practice Address - Fax:507-645-9203
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2982-35152W00000X
IL046-009596152W00000X
MA4618152W00000X
MN3198152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0718203Medicaid
MA000140501Medicare PIN
MA0718203Medicaid