Provider Demographics
NPI:1467471516
Name:DR HENRY A HULL OPTOMETRIST, INC
Entity Type:Organization
Organization Name:DR HENRY A HULL OPTOMETRIST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:830-625-5716
Mailing Address - Street 1:147 FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-5434
Mailing Address - Country:US
Mailing Address - Phone:830-625-5716
Mailing Address - Fax:830-625-5773
Practice Address - Street 1:147 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-5434
Practice Address - Country:US
Practice Address - Phone:830-625-5716
Practice Address - Fax:830-625-5773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02342TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCP3043OtherRR MEDICARE
TX0017PUOtherBLUE CROSS BLUE SHIELD
TX00Z481Medicare PIN
TXT13965Medicare UPIN
TX0256870001Medicare NSC