Provider Demographics
NPI:1003818915
Name:HENRI, MONA A (OD)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:A
Last Name:HENRI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 4TH ST N STE A
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-4300
Mailing Address - Country:US
Mailing Address - Phone:727-894-0500
Mailing Address - Fax:727-823-8697
Practice Address - Street 1:2201 4TH ST N STE A
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-4300
Practice Address - Country:US
Practice Address - Phone:727-894-0500
Practice Address - Fax:727-823-8697
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2526152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078852000Medicaid
FL078852000Medicaid
FL20304TMedicare ID - Type UnspecifiedOAF GROUP K0738A
FM20304UMedicare ID - Type UnspecifiedOAF GROUP K0738