Healthcare Provider Details

I. General information

NPI: 1760059836
Provider Name (Legal Business Name): ASHA MCHENRY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 CHARLES ST
BOSTON MA
02114-3096
US

IV. Provider business mailing address

243 CHARLES ST
BOSTON MA
02114-3096
US

V. Phone/Fax

Practice location:
  • Phone: 617-573-4177
  • Fax:
Mailing address:
  • Phone: 617-573-4177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5480
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: