Provider Demographics
NPI:1316396591
Name:MCHENRY, PAUL VINCENT (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:VINCENT
Last Name:MCHENRY
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 1:4875 WARD RD STE 600
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-1944
Mailing Address - Country:US
Mailing Address - Phone:303-456-9456
Mailing Address - Fax:303-467-0145
Practice Address - Street 1:4875 WARD RD STE 600
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-1944
Practice Address - Country:US
Practice Address - Phone:303-456-9456
Practice Address - Fax:303-467-0145
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003565152W00000X
PAOEG003149152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy