Healthcare Provider Details

I. General information

NPI: 1982664116
Provider Name (Legal Business Name): SCOTT J HENRY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WINCHESTER AVE UNIT 810
ASHLAND KY
41101-7362
US

IV. Provider business mailing address

132 WILLOWOOD CIR
HURRICANE WV
25526-9272
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-3672
  • Fax:
Mailing address:
  • Phone: 304-546-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10241269-9934
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0936-IOD
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.006517
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2091DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: