Provider Demographics
NPI:1710051131
Name:FRANKLIN, HENRY LAVERN (OD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:LAVERN
Last Name:FRANKLIN
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:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-0003
Mailing Address - Country:US
Mailing Address - Phone:843-549-6636
Mailing Address - Fax:
Practice Address - Street 1:1112 HAMPTON STREET
Practice Address - Street 2:STE D
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-4168
Practice Address - Country:US
Practice Address - Phone:843-579-6636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC630152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC218933Medicaid
SC0608140001Medicare NSC
SCT249290281Medicare ID - Type Unspecified
SC218933Medicaid