Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | S-E11 | AL |
NPI | 1003301664 |
---|---|
Provider Name | Dr. Haley Henson |
First Address | Tuscaloosa, AL 35406-4411 |
Second Address | Tuscaloosa, AL 35405-8785 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2018 |
Last Update Date | 05/01/2022 |