Provider Demographics
NPI:1942477864
Name:HEIDI L. SCHEFFERLY O.D., L. L.C.
Entity type:Organization
Organization Name:HEIDI L. SCHEFFERLY O.D., L. L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SCHEFFLERY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-783-6928
Mailing Address - Street 1:306 W WASHINGTON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2141
Mailing Address - Country:US
Mailing Address - Phone:517-783-6928
Mailing Address - Fax:517-784-9633
Practice Address - Street 1:306 W WASHINGTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2141
Practice Address - Country:US
Practice Address - Phone:517-783-6928
Practice Address - Fax:517-784-9633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003898152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty