1780771337 NPI number — DR. SHARON F HENDERSON OD

Table of content: DR. SHARON F HENDERSON OD (NPI 1780771337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780771337 NPI number — DR. SHARON F HENDERSON OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENDERSON
Provider First Name:
SHARON
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

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:
1780771337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 W MAIN ST
Provider Second Line Business Mailing Address:
LENSCRAFTERS
Provider Business Mailing Address City Name:
AVON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06001-3690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-409-4565
Provider Business Mailing Address Fax Number:
860-409-4566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 W MAIN ST
Provider Second Line Business Practice Location Address:
LENSCRAFTERS
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06001-3690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-409-4565
Provider Business Practice Location Address Fax Number:
860-409-4566
Provider Enumeration Date:
10/06/2006

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:  CT002456 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 090002456CT13 . This is a "BCBS PIN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 566721-6484 . This is a "CONNECTICARE PIN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 061623189 . This is a "AETNA PIN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 061623189 . This is a "UHC PIN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: OV9631 . This is a "HEALTHNET PIN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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