MEDICARE: JOHN L. HENAHAN, OD, POC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1013188952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN L. HENAHAN, OD, POC

Provider Business Mailing Address
First Line	:	361 HIGHWAY 74 N
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-1102
Country	:	US
Telephone Number	:	770-487-0667
Fax Number	:	770-487-0947

Provider Business Practice Location Address
First Line	:	361 HIGHWAY 74 N
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-1102
Country	:	US
Telephone Number	:	770-487-0667
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN L HENAHAN
Credential	:	OD
Telephone Number	:	770-487-0667

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	08/01/2025

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