Provider Demographics
NPI:1124543079
Name:HENLEY, KACY ANN (OD)
Entity type:Individual
Prefix:DR
First Name:KACY
Middle Name:ANN
Last Name:HENLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KACY
Other - Middle Name:ANN
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9102 S. TOLEDO AVE. # A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2741
Mailing Address - Country:US
Mailing Address - Phone:918-742-2055
Mailing Address - Fax:918-742-0991
Practice Address - Street 1:9102 S. TOLEDO AVE. #A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2741
Practice Address - Country:US
Practice Address - Phone:918-742-2055
Practice Address - Fax:918-742-0991
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist