Provider Demographics
NPI:1417076852
Name:HENION, STEPHEN W (LO LICENSED OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:W
Last Name:HENION
Suffix:
Gender:M
Credentials:LO LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 EDDY ST
Mailing Address - Street 2:
Mailing Address - City:OAKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06779-1042
Mailing Address - Country:US
Mailing Address - Phone:203-759-1611
Mailing Address - Fax:206-759-1707
Practice Address - Street 1:910 WOLCOTT ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-1317
Practice Address - Country:US
Practice Address - Phone:203-759-1611
Practice Address - Fax:203-759-1707
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTL01041156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT200001124CT01OtherANTHEM BCBS
CT0536620001Medicare ID - Type Unspecified