Provider Demographics
NPI:1033456389
Name:MICHAEL S HENDERSON OD PA
Entity Type:Organization
Organization Name:MICHAEL S HENDERSON OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SENTMAN
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-757-7160
Mailing Address - Street 1:167 BLUFFTON RD STE F
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6228
Mailing Address - Country:US
Mailing Address - Phone:843-757-7160
Mailing Address - Fax:843-757-8464
Practice Address - Street 1:167 BLUFFTON RD STE F
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6228
Practice Address - Country:US
Practice Address - Phone:843-757-7160
Practice Address - Fax:843-757-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC879152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty