Provider Demographics
NPI:1770565772
Name:HULL, HENRY A (OD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:A
Last Name:HULL
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 1:147 FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-5434
Mailing Address - Country:US
Mailing Address - Phone:830-625-5716
Mailing Address - Fax:830-625-5773
Practice Address - Street 1:147 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-5434
Practice Address - Country:US
Practice Address - Phone:830-625-5716
Practice Address - Fax:830-625-5773
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02342TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX410015119OtherRR MEDICARE
TX8AD886OtherBLUE CROSS BLUE SHIELD
TX8AD886OtherBLUE CROSS BLUE SHIELD
TX0256870001Medicare NSC
TX8F8610Medicare PIN