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General NPI Number Information
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NPI Number | 1740420983
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Entity Type | Organization
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Legal Business Name | HENRY VISION CENTER LLC
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Dates
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Enumeration Date | 02/28/2009
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 3564 HIGHWAY 138 SE
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-4170
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Country | US
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Telephone | 770-474-5617
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Fax | 770-474-6576
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Provider Business Mailing Address
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Address Line | 3564 HIGHWAY 138 SE
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-4170
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Country | US
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Telephone | 770-474-5617
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Fax | 770-474-6576
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Authorized Official
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Title or Position | CEO/OPTOMETRIST
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Name | NICKSON HENRY
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Credential | OD
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Telephone | 770-474-5617
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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 |
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