Provider Demographics
NPI:1447992615
Name:GAY, HEATHER (OD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GAY
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 WOOD VIEW DR
Mailing Address - Street 2:
Mailing Address - City:EAST BERNSTADT
Mailing Address - State:KY
Mailing Address - Zip Code:40729-6564
Mailing Address - Country:US
Mailing Address - Phone:606-261-8875
Mailing Address - Fax:606-598-7972
Practice Address - Street 1:231 WHITE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-1214
Practice Address - Country:US
Practice Address - Phone:606-598-2219
Practice Address - Fax:606-598-7972
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY2276DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program