Provider Demographics
NPI:1306037668
Name:AMY D HENSON OD PLLC
Entity Type:Organization
Organization Name:AMY D HENSON OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-330-0946
Mailing Address - Street 1:1360 WILLIE CHEEK RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-7445
Mailing Address - Country:US
Mailing Address - Phone:606-330-0946
Mailing Address - Fax:606-330-0946
Practice Address - Street 1:1360 WILLIE CHEEK RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-7445
Practice Address - Country:US
Practice Address - Phone:606-330-0946
Practice Address - Fax:606-330-0946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1574DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA340891OtherANTHEM
VA00X571A01Medicare PIN
VAC10356Medicare PIN