Provider Demographics
NPI:1780771337
Name:HENDERSON, SHARON F (OD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:F
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 1:380 W MAIN ST
Mailing Address - Street 2:LENSCRAFTERS
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3690
Mailing Address - Country:US
Mailing Address - Phone:860-409-4565
Mailing Address - Fax:860-409-4566
Practice Address - Street 1:380 W MAIN ST
Practice Address - Street 2:LENSCRAFTERS
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3690
Practice Address - Country:US
Practice Address - Phone:860-409-4565
Practice Address - Fax:860-409-4566
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT002456152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT090002456CT13OtherBCBS PIN
CT566721-6484OtherCONNECTICARE PIN
CT061623189OtherAETNA PIN
CT061623189OtherUHC PIN
CTOV9631OtherHEALTHNET PIN
CT090002456CT13OtherBCBS PIN