1871612408 NPI number — DR. NOEL HENRY O.D.

Table of content: DR. NOEL HENRY O.D. (NPI 1871612408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871612408 NPI number — DR. NOEL HENRY O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENRY
Provider First Name:
NOEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871612408
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13506 SUMMERPORT VILLAGE PKWY
Provider Second Line Business Mailing Address:
SUITE 254
Provider Business Mailing Address City Name:
WINDERMERE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34786-7366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-288-3032
Provider Business Mailing Address Fax Number:
407-877-3276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2855 N OLD LAKE WILSON ROAD
Provider Second Line Business Practice Location Address:
LOCATED INSIDE WALMART 5214
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34747-1821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-654-0181
Provider Business Practice Location Address Fax Number:
407-877-4471
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPC3970 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 27451 . This is a "SPECTERA & UNITED #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 621002300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3330 . This is a "SUPERIOR VISION#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 51694 . This is a "DAVIS VISION #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 919009 . This is a "BLOCK VISION #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: AO2695 . This is a "EYEMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 196608 . This is a "GREATWEST #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: K9038 . This is a "GROUP NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 621002300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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