Individual
DR. CRAIG ALAN HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0E007172T
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0013931540004
MEDICAL ASSISTANCE GROUP
—
05
—
0013931540004
—
PA
01
—
1611141
639069
—
01
—
50003075
BLUE CROSS
—
01
—
U08433
HEALTH AMERICA
—
Enumeration date
05/10/2006
Last updated
09/26/2011
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