Healthcare Provider Details

I. General information

NPI: 1699838318
Provider Name (Legal Business Name): ALLISON A HENDERSON OD AND WILLIAM E HENDERSON II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 CENTRAL CENTER
CHILLICOTHEE OH
45601
US

IV. Provider business mailing address

PO BOX 453
CHILLICOTHEE OH
45601-0453
US

V. Phone/Fax

Practice location:
  • Phone: 740-774-2106
  • Fax: 740-774-2107
Mailing address:
  • Phone: 740-774-2106
  • Fax: 740-774-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLISON A HENDERSON
Title or Position: PARTNER
Credential: OD
Phone: 740-774-2106