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General NPI Number Information
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NPI Number | 1376943563
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Entity Type | Organization
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Legal Business Name | HENDERSON FAMILY EYE CARE, PLLC
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Dates
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Enumeration Date | 08/26/2014
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Last Update Date | 08/26/2014
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Provider Practice Location Address
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Address Line | 401 E MAIN ST
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City | HENDERSON
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State | TN
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Zip | 38340-2439
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Country | US
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Telephone | 731-435-1275
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Fax | 731-435-1276
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Provider Business Mailing Address
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Address Line | 401 E MAIN ST
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City | HENDERSON
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State | TN
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Zip | 38340-2439
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Country | US
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Telephone | 731-435-1275
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Fax | 731-435-1276
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Authorized Official
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Title or Position | OWNER
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Name | KAREN NICOLE JOHNSON
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Credential | O.D.
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Telephone | 731-435-1275
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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 |
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License Number State | TN
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