Provider Demographics
NPI:1477681138
Name:HENDERSON EYE ASSOCIATION, INC
Entity Type:Organization
Organization Name:HENDERSON EYE ASSOCIATION, INC
Other - Org Name:HENDERSON EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-657-1539
Mailing Address - Street 1:1787 HIGHWAY 79 SOUTH
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75654-4509
Mailing Address - Country:US
Mailing Address - Phone:903-657-1539
Mailing Address - Fax:903-657-0259
Practice Address - Street 1:1787 HIGHWAY 79 SOUTH
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75654-4509
Practice Address - Country:US
Practice Address - Phone:903-657-1539
Practice Address - Fax:903-657-0259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5144TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142624902Medicaid
TXDD3079OtherMEDICARE RAILROAD
TX8F7864OtherBLUE CROSS AND BLUE SHIELD
TX00Z051Medicare PIN
TX142624902Medicaid