Provider Demographics
NPI:1679532345
Name:ALCORN, HEATHER L (OD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L
Last Name:ALCORN
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 1:401 S PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44632-9401
Mailing Address - Country:US
Mailing Address - Phone:330-319-4067
Mailing Address - Fax:
Practice Address - Street 1:4790 PORTAGE ST NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7245
Practice Address - Country:US
Practice Address - Phone:330-497-8428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5282152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5282/T2191OtherLICENSE/THERAPEUTIC
U93278Medicare UPIN
OHOH5282OtherEYEMED NUMBER
OH5282/T2191OtherLICENSE/THERAPEUTIC