Provider Demographics
NPI:1871612408
Name:HENRY, NOEL (OD)
Entity type:Individual
Prefix:DR
First Name:NOEL
Middle Name:
Last Name:HENRY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13506 SUMMERPORT VILLAGE PKWY
Mailing Address - Street 2:SUITE 254
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-7366
Mailing Address - Country:US
Mailing Address - Phone:954-288-3032
Mailing Address - Fax:407-877-3276
Practice Address - Street 1:2855 N OLD LAKE WILSON ROAD
Practice Address - Street 2:LOCATED INSIDE WALMART 5214
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-1821
Practice Address - Country:US
Practice Address - Phone:407-654-0181
Practice Address - Fax:407-877-4471
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3970152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27451OtherSPECTERA & UNITED #
FL621002300Medicaid
FL3330OtherSUPERIOR VISION#
FL51694OtherDAVIS VISION #
FL919009OtherBLOCK VISION #
FLAO2695OtherEYEMED
FL196608OtherGREATWEST #
FLK9038OtherGROUP NUMBER
FL919009OtherBLOCK VISION #
FLK9038OtherGROUP NUMBER