Provider Demographics
NPI:1538476007
Name:HENNEY, SARA JUSTINE (OD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:JUSTINE
Last Name:HENNEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 9TH ST SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-4312
Mailing Address - Country:US
Mailing Address - Phone:772-257-8224
Mailing Address - Fax:772-213-3157
Practice Address - Street 1:12196 COUNTY ROAD 512
Practice Address - Street 2:
Practice Address - City:FELLSMERE
Practice Address - State:FL
Practice Address - Zip Code:32948-5463
Practice Address - Country:US
Practice Address - Phone:772-257-8224
Practice Address - Fax:772-213-3157
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4591152W00000X
FLOPC 4591152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC4591OtherSTATE LICENSE