Provider Demographics
NPI:1174521769
Name:BULLARD, HEATH L (OD)
Entity type:Individual
Prefix:DR
First Name:HEATH
Middle Name:L
Last Name:BULLARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:839 N NOLAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7001
Mailing Address - Country:US
Mailing Address - Phone:817-645-2411
Mailing Address - Fax:817-645-3447
Practice Address - Street 1:839 N NOLAN RIVER RD
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7001
Practice Address - Country:US
Practice Address - Phone:817-645-2411
Practice Address - Fax:817-645-2189
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5894152W00000X
TX5894TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0463648-01Medicaid
TX23910OtherOPTICARE
TX80286QOtherBLUE CROSS BLUE SHIELD
TX23910OtherOPTICARE
TXU81381Medicare UPIN
TX0463648-01Medicaid
TX410045187Medicare PIN