Provider Demographics
NPI:1750951224
Name:HEYSE, HOLLY (OD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:
Last Name:HEYSE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:KNOECHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 BLUE HERON DR
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-1368
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 GLASTONBURY BLVD STE 17
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4405
Practice Address - Country:US
Practice Address - Phone:860-659-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3205152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist