Provider Demographics
NPI:1548210818
Name:HENRY, CRAIG ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALAN
Last Name:HENRY
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 1:5012 CARLISLE PIKE
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050
Mailing Address - Country:US
Mailing Address - Phone:717-763-2020
Mailing Address - Fax:717-901-6565
Practice Address - Street 1:5012 CARLISLE PIKE
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050
Practice Address - Country:US
Practice Address - Phone:717-763-2020
Practice Address - Fax:717-901-6565
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0E007172T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013931540004Medicaid
0013931540004OtherMEDICAL ASSISTANCE GROUP
50003075OtherBLUE CROSS
1611141Other639069
U08433OtherHEALTH AMERICA
1611141Other639069
PA639069Medicare ID - Type Unspecified