| Doctor Name: | LOUELLA MARIE HEATH |
| NPI Number: | 1215039540 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 1270 Kotnum Road Warm Springs, OR - 97761 |
| Business Phone Number: | 5415531196 |
| Business Fax Number: | 5415532162 |
| Mailing Address: | 1270 Kotnum Road, Po Box 1209 WARM SPRINGS |
| State: | OR |
| Postal Code: | 97761 |
| Phone Number: | 5415531196 |
| Fax Number: | 5415532162 |
| NPI Enumeration Date: | 09/05/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1202X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optometric Technician |
| Taxonomy Definition: | |