# GREGORY D HEATON OD PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** JAY VISION CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003090556
- **Authorized official:** ANGEL KELLEY (DELEGATED OFFICIAL)
- **Authorized official phone:** (850) 675-0625

## Contact information

- **Practice address:** 14088 ALABAMA ST, JAY, FL 32565-1036
- **Practice address phone:** (850) 675-0625
- **Mailing address:** PO BOX 25, JAY, FL 32565-0025
- **Mailing address phone:** (850) 675-0625

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OPC3531 | FL | Yes |

## Other

- **Enumeration date:** 12/19/2007
- **Last updated:** 06/15/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 621048100 | — | FL |