Provider Demographics
NPI:1063453488
Name:HENNIS OPHTHALMOLOGY
Entity Type:Organization
Organization Name:HENNIS OPHTHALMOLOGY
Other - Org Name:HENNIS EYE ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PERINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-783-9222
Mailing Address - Street 1:1008 OLD ROCKFORD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-5361
Mailing Address - Country:US
Mailing Address - Phone:366-783-9222
Mailing Address - Fax:336-783-9224
Practice Address - Street 1:1008 OLD ROCKFORD ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-5361
Practice Address - Country:US
Practice Address - Phone:366-783-9222
Practice Address - Fax:336-783-9224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36197156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty