Provider Demographics
NPI:1669706495
Name:HENSLEY, SEAN MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MICHAEL
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:123 ED SCHMIDT BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-5585
Mailing Address - Country:US
Mailing Address - Phone:979-220-8892
Mailing Address - Fax:
Practice Address - Street 1:123 ED SCHMIDT BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5585
Practice Address - Country:US
Practice Address - Phone:979-220-8892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-26
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7466T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist