Provider Demographics
NPI:1770687840
Name:HENRY, AMY DEARIXON (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:DEARIXON
Last Name:HENRY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6380 N NAVARRO ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1721
Mailing Address - Country:US
Mailing Address - Phone:361-570-2010
Mailing Address - Fax:361-570-2012
Practice Address - Street 1:6380 N NAVARRO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1721
Practice Address - Country:US
Practice Address - Phone:361-570-2010
Practice Address - Fax:361-570-2012
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5649T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5649TOtherTEXAS OPTOMETRY LICENSE
TX8210SQOtherBCBS OF TEXAS
TX8210SQOtherBCBS OF TEXAS
TX8F6436Medicare PIN