Provider Demographics
NPI:1295715936
Name:HENRY EYE CLINIC
Entity type:Organization
Organization Name:HENRY EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MORRISS
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-442-5227
Mailing Address - Street 1:741 E VAN ASCHE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4916
Mailing Address - Country:US
Mailing Address - Phone:479-442-5227
Mailing Address - Fax:479-582-4952
Practice Address - Street 1:741 E VAN ASCHE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4916
Practice Address - Country:US
Practice Address - Phone:479-442-5227
Practice Address - Fax:479-582-4952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR132227002Medicaid
AR180032208OtherRAILROAD MEDICARE
AR57440OtherBLUE CROSS
AR132227002Medicaid
AR0204560001Medicare NSC
AR57440Medicare PIN