Provider Demographics
NPI:1255469730
Name:MAGEE, HENRY M (OD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:M
Last Name:MAGEE
Suffix:
Gender:M
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:066-877-1877
Mailing Address - Fax:606-877-0082
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:606-877-0082
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY878DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77008787Medicaid
KY000000188338OtherANTHEM
KY77008787Medicaid
KY0444900001Medicare NSC