Richard Henderson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1217DT Issued in KY

Practice address

1609 N Dixie Hwy
Elizabethtown, KY 42701-6473

Phone

(270) 765-7372

Fax

(270) 737-3936

NPI assigned

Dec 22, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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

• Ky Doctors of Optometry, PLLC

  dba KY Doctors of Optometry

  • Eyewear Supplier
  • Elizabethtown, KY
  • NPI 1427131176

  Optometrist

  NPD (past)

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

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669537528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11103 WEST AVE",
            "address_2": "SUITE 6",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782131370",
            "telephone_number": "210-524-6663",
            "fax_number": "210-524-6587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 N DIXIE HWY",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427016473",
            "telephone_number": "270-765-7372",
            "fax_number": "270-737-3936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "RICHARD",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1217DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77012177",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren Alea Helsel
• Cathy B Helson
• Delaney Helton
• Adam Henderson
• Myra A Henderson, D.O.
• Tamathy Henderson, LPCC
• Thomas James Henderson, M.D.
• Ann H Hendrick
• Amanda Sue Hendricks, APRN
• Laura Denice Henriott

• Optometrist in Elizabethtown, KY
• Providers in Elizabethtown, KY by specialty
• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.