Provider Demographics
NPI:1871901231
Name:SUTTON, HEATHER NICOLE (OD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICOLE
Last Name:SUTTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:NICOLE
Other - Last Name:THIGPEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 COLLEGE ST STE B
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2714
Mailing Address - Country:US
Mailing Address - Phone:256-233-2393
Mailing Address - Fax:256-233-2309
Practice Address - Street 1:110 COLLEGE ST STE B
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2714
Practice Address - Country:US
Practice Address - Phone:256-233-2393
Practice Address - Fax:256-233-2309
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-D21-TA-986152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist