Provider Demographics
NPI:1891975314
Name:HENSON, KAREN ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANN
Last Name:HENSON
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 1:1630 W STATE HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-5138
Mailing Address - Country:US
Mailing Address - Phone:979-968-8987
Mailing Address - Fax:979-968-8757
Practice Address - Street 1:1630 W STATE HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-5138
Practice Address - Country:US
Practice Address - Phone:979-968-8987
Practice Address - Fax:979-968-8757
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4484T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AW325OtherBCBS
TX00E48ZOtherBCBS
TX8AW325OtherBCBS
TX8C7842Medicare PIN