MEDICARE: HENRY EYE CLINIC

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	207W00000X	Ophthalmology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	180032208	OTHER	AR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	57440	OTHER	AR	BLUE CROSS

General Provider Information

NPI Number	:	1295715936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY EYE CLINIC

Provider Business Mailing Address
First Line	:	741 E VAN ASCHE DR
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-4916
Country	:	US
Telephone Number	:	479-442-5227
Fax Number	:	479-582-4952

Provider Business Practice Location Address
First Line	:	741 E VAN ASCHE DR
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-4916
Country	:	US
Telephone Number	:	479-442-5227
Fax Number	:	479-582-4952

Authorized Official
Title or Position	:	OPHTHALMOLOGIST
Name	:	DR. PAUL MORRISS HENRY
Credential	:	M.D.
Telephone Number	:	479-442-5227

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	09/21/2023

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Directions to “HENRY EYE CLINIC ” Practice Location

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