Individual
GARY DENNIS HEINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICENSED OPTICIAN
Contact information
Practice address
117 WASHINGTON AVE, NORTH HAVEN, CT 06473-1769
(203) 239-6172
(203) 239-0295
Mailing address
117 WASHINGTON AVE, NORTH HAVEN, CT 06473-1769
(203) 239-6172
(203) 239-0295
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
LO-# 715
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0648180001
NSC--NUMBER
CT
01
—
100000715CT-01
BLUE CROSS PROVIDER
CT
01
—
61-1442432
FEDERAL TAX
CT
Enumeration date
03/09/2007
Last updated
07/15/2008
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