Provider Demographics
NPI:1689642662
Name:HENRY, LARRY CHRIS (OD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:CHRIS
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 1:160 CEDAR RDG
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1664
Mailing Address - Country:US
Mailing Address - Phone:724-287-2749
Mailing Address - Fax:
Practice Address - Street 1:106 MILHEIM DR
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1515
Practice Address - Country:US
Practice Address - Phone:724-282-3265
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE004850P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU08087Medicare UPIN
PA289071Medicare ID - Type UnspecifiedINDIVIDUAL