Individual
LARRY RANDALL HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
14701 N SANTA FE AVE, EDMOND, OK 73013-3411
(405) 752-2733
(405) 752-2172
Mailing address
14701 N SANTA FE AVE, EDMOND, OK 73013-3411
(405) 752-2733
(405) 752-2172
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2040
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100765720A
—
OK
01
—
1677321
UNITED HEALTHCARE
OK
01
—
4628540
AETNA
OK
Enumeration date
05/24/2005
Last updated
05/08/2008
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