Individual provider Active NPI

Katherine Lynn Henning, OD

  • Optometrist
  • Galax, VA
National Provider Identifier
1124095708
Registry record updated Sep 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0618001546 Issued in VA
Practice address
1102 E Stuart Dr
Galax, VA 24333-2514
Phone
(276) 236-4171
Fax
(276) 236-0909
NPI assigned
Mar 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1710 NC
Optometrist 152W00000X 0618001546 VA Primary

Addresses

Primary practice location

1102 E Stuart Dr
Galax, VA 24333-2514

Mailing address

1102 E Stuart Dr
Galax, VA 24333-2514
Phone (276) 236-4171

Other identifiers 3

IdentifierTypeStateIssuer
010236789MedicaidVA
010236584MedicaidVA
890925LMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060221000358 VA Practitioner - Optometry 6800802398 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Blue Ridge Eye Care Associates, PLLCGroup PAC ID 8426064916, 4 clinicians

Practice addresses (Care Compare)

800 E Stuart Dr
Galax, VA 24333-2321
Phone (276) 236-4171

Merit-based Incentive Payment System (MIPS)

Final score
88.32 of 100Reported as group
Quality
76.64
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery72

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1710NCMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Ridge Eye Care Associates PLLC Optometrist CurrentSince Jan 1, 2006 Accepting new patients
Oliver Optometric Eye Care Optometrist PastSince Apr 15, 2021 Accepting new patients
Schonhofen Optometry PA Optometrist Past Accepting new patients

Locations

800 E Stuart Dr
Galax, VA 24333
Phone (276) 236-4171

1102 E Stuart Dr
Galax, VA 24333
Phone (276) 236-4171

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348790400000",
    "number": "1124095708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 E STUART DR",
            "city": "GALAX",
            "state": "VA",
            "postal_code": "243332514",
            "telephone_number": "276-236-4171",
            "fax_number": "276-236-0909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 E STUART DR",
            "city": "GALAX",
            "state": "VA",
            "postal_code": "243332514",
            "telephone_number": "276-236-4171",
            "fax_number": "276-236-0909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENNING",
        "first_name": "KATHERINE",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-02",
        "last_updated": "2012-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1710",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618001546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010236789",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010236584",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890925L",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Galax, VA

Sources for this page

Verify at the official NPI Registry.