| Doctor Name: | MICHAEL DANIEL HENDERSON |
| NPI Number: | 1366501231 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.D.O. |
| License Number: | DO3183FL |
| Business Practice Address: | 10365 S E Hwy 441 Belleview, FL - 34420 |
| Business Phone Number: | 3522453822 |
| Business Fax Number: | 3522454668 |
| Mailing Address: | 10365 S E Hwy 441, BELLEVIEW |
| State: | FL |
| Postal Code: | 34420 |
| Phone Number: | 3522453822 |
| Fax Number: | 3522454668 |
| NPI Enumeration Date: | 12/07/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | DO3183FL |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |