Provider Demographics
NPI:1366762361
Name:BLANK, HEATHER (OPTICIAN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BLANK
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:DR
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:FREUNDLICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:86 MANETTO HILL MALL
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803
Mailing Address - Country:US
Mailing Address - Phone:516-935-0899
Mailing Address - Fax:
Practice Address - Street 1:86 MANETTO HILL MALL
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803
Practice Address - Country:US
Practice Address - Phone:516-935-0899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005376-1152W00000X
NYC006425-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician