Provider Demographics
NPI:1730340290
Name:HARLEY W HENION OPTICIAN INC
Entity type:Organization
Organization Name:HARLEY W HENION OPTICIAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:HENION
Authorized Official - Suffix:
Authorized Official - Credentials:LO
Authorized Official - Phone:203-757-7606
Mailing Address - Street 1:501 FROST RD
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705
Mailing Address - Country:US
Mailing Address - Phone:203-757-7606
Mailing Address - Fax:203-757-1781
Practice Address - Street 1:501 FROST RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705
Practice Address - Country:US
Practice Address - Phone:203-757-7606
Practice Address - Fax:203-757-1781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTL01041156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT200001124CT01OtherANTHEM BC
0536620001Medicare NSC