Provider Demographics
NPI:1053595736
Name:DR CRYSTAL S HEFNER
Entity type:Organization
Organization Name:DR CRYSTAL S HEFNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:HEFNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-464-6030
Mailing Address - Street 1:PO BOX 582
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-0582
Mailing Address - Country:US
Mailing Address - Phone:828-464-6030
Mailing Address - Fax:828-465-6339
Practice Address - Street 1:130 1ST ST W
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-2106
Practice Address - Country:US
Practice Address - Phone:828-464-6030
Practice Address - Fax:828-465-6339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC0990332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC0990OtherEYEMED VISION CARE
NC10261OtherOPTICARE
NC271874OtherMAMSI
NC09833OtherBLUE CROSS BLUE SHIELD NC
NC09833OtherNC HEALTH CHOICE
NC8909833Medicaid
NC09833OtherNC STATE EMPLOYEES
NC2242466OtherUNITED HEALTHCARE
NC8909833OtherNC DIVISION OF THE BLIND
NC10261OtherOPTICARE
NCT64839Medicare UPIN
NCNC0990OtherEYEMED VISION CARE