Individual
RICHARD HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1609 N DIXIE HWY, ELIZABETHTOWN, KY 42701-6473
(270) 765-7372
(270) 737-3936
Mailing address
11103 WEST AVE, SUITE 6, SAN ANTONIO, TX 78213-1370
(210) 524-6663
(210) 524-6587
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1217DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77012177
—
KY
Enumeration date
12/22/2006
Last updated
07/08/2007
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