Provider Demographics
NPI:1679137343
Name:HEGENER, COURTNEY LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:LYNN
Last Name:HEGENER
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 1:4615 TILLMAN BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-4965
Mailing Address - Country:US
Mailing Address - Phone:229-630-9500
Mailing Address - Fax:
Practice Address - Street 1:2500 WINCHESTER PL
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-1550
Practice Address - Country:US
Practice Address - Phone:864-300-4498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-27
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2130152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist