Provider Demographics
NPI:1699838318
Name:ALLISON A HENDERSON OD AND WILLIAM E HENDERSON II
Entity Type:Organization
Organization Name:ALLISON A HENDERSON OD AND WILLIAM E HENDERSON II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-774-2106
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-0453
Mailing Address - Country:US
Mailing Address - Phone:740-774-2106
Mailing Address - Fax:740-774-2107
Practice Address - Street 1:612 CENTRAL CENTER
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601
Practice Address - Country:US
Practice Address - Phone:740-774-2106
Practice Address - Fax:740-774-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3497809Medicaid
T45967Medicare UPIN
0394510001Medicare ID - Type UnspecifiedADMINISTAR GROUP CHILLICO
CC0224Medicare ID - Type UnspecifiedRAILROAD GROUP
GU9293511Medicare ID - Type UnspecifiedMEDICARE CHILLICOTHE
OH3497809Medicaid