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NPI Code Detail

MEDICARE: KEVIN L HENNE OD

MEDICARE: KEVIN L HENNE OD
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
1152W00000XOptometristFL1655FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
141000187OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407847585
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN L HENNE OD
Provider Business Mailing Address
First Line : 410 E CENTRAL AVE
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33880-3050
Country : US
Telephone Number : 863-293-0276
Fax Number : 863-299-3172
Provider Business Practice Location Address
First Line : 410 E CENTRAL AVE
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33880-3050
Country : US
Telephone Number : 863-293-0276
Fax Number : 863-299-3172
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2005
Last Update Date : 04/24/2009

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