Provider Demographics
NPI:1508234253
Name:HENEIN, ANTOUN
Entity Type:Individual
Prefix:
First Name:ANTOUN
Middle Name:
Last Name:HENEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 SPOTSYLVANIA MALL
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-1123
Mailing Address - Country:US
Mailing Address - Phone:540-786-2272
Mailing Address - Fax:540-786-3793
Practice Address - Street 1:440 SPOTSYLVANIA MALL
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-1123
Practice Address - Country:US
Practice Address - Phone:540-786-2272
Practice Address - Fax:540-786-3793
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician