Provider Demographics
NPI:1033106653
Name:HENSON, AMY DENISE (OD)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:DENISE
Last Name:HENSON
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 1:503 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1217
Mailing Address - Country:US
Mailing Address - Phone:606-877-1877
Mailing Address - Fax:606-878-9543
Practice Address - Street 1:503 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1217
Practice Address - Country:US
Practice Address - Phone:606-877-1877
Practice Address - Fax:606-878-9543
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1574DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77902260Medicaid
KY000000291821OtherANTHEM
KY77000800Medicaid
KYP00036619Medicare PIN
KY000000291821OtherANTHEM
KY0451310001Medicare NSC
KY8454Medicare PIN
U95765Medicare UPIN
KY77902260Medicaid