Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC2526 | FL |
NPI | 1003818915 |
---|---|
Provider Name | Dr. Mona A Henri |
First Address | St Petersburg, FL 33704-4300 |
Second Address | St Petersburg, FL 33704-4300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 11/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
078852000 | (05) | FL |
U24553 | (02) | FL |