Provider Demographics
NPI:1043389281
Name:STOREY, HENRY FRANK (OD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:FRANK
Last Name:STOREY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:H.
Other - Middle Name:F
Other - Last Name:STOREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:515 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-1729
Mailing Address - Country:US
Mailing Address - Phone:503-769-3441
Mailing Address - Fax:503-769-1419
Practice Address - Street 1:515 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-1729
Practice Address - Country:US
Practice Address - Phone:503-769-3441
Practice Address - Fax:503-769-1419
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1174ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181982Medicaid
OR410023887Medicare PIN
ORT76655Medicare UPIN
OR181982Medicaid
ORR0000PHMBNMedicare PIN