MEDICARE: MICHAEL S HENDERSON OD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	879	SC

General Provider Information

NPI Number	:	1033456389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL S HENDERSON OD PA

Provider Business Mailing Address
First Line	:	167 BLUFFTON RD STE F
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-6228
Country	:	US
Telephone Number	:	843-757-7160
Fax Number	:	843-757-8464

Provider Business Practice Location Address
First Line	:	167 BLUFFTON RD STE F
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-6228
Country	:	US
Telephone Number	:	843-757-7160
Fax Number	:	843-757-8464

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL SENTMAN HENDERSON
Credential	:	OD
Telephone Number	:	843-757-7160

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	01/07/2013

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