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General NPI Number Information
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NPI Number | 1306931597
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Entity Type | Organization
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Legal Business Name | HENDERSON VISION CENTER
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 2600 MCINGVALE RD
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City | HERNANDO
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State | MS
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Zip | 38632-8658
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Country | US
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Telephone | 662-429-7099
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Fax | 662-469-4091
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Provider Business Mailing Address
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Address Line | 555 BENDING OAK S
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City | HERNANDO
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State | MS
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Zip | 38632-6558
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Country | US
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Telephone | 901-864-3119
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Fax | 662-469-4091
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Authorized Official
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Title or Position | OWNER
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Name | KENYA HENDERSON
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Credential |
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Telephone | 662-429-7099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 741
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License Number State | MS
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