Individual
DALE D HEASTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1129
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0144211
WA LABOR & INDUSTRY
WA
01
—
11102
GROUP HEALTH
—
01
—
4100016629
RAILROAD MEDICARE
—
01
—
HE6761
BLUE CROSS BLUE SHIELD
—
Enumeration date
08/28/2006
Last updated
03/07/2023
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