Provider Demographics
NPI:1922396381
Name:HENDERSON, ALLISON A (OD)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:A
Last Name:HENDERSON
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 1:612 CENTRAL CTR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2248
Mailing Address - Country:US
Mailing Address - Phone:740-774-2106
Mailing Address - Fax:740-774-2107
Practice Address - Street 1:612 CENTRAL CTR
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
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6042/T2957152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
H018779OtherPTAN MEDICARE