Provider Demographics
NPI:1174615983
Name:HENNINGER, JAMES PAUL (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PAUL
Last Name:HENNINGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:50 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:PA
Mailing Address - Zip Code:17851-1300
Mailing Address - Country:US
Mailing Address - Phone:570-339-2300
Mailing Address - Fax:570-339-6011
Practice Address - Street 1:963 CHESTNUT ST OFC B
Practice Address - Street 2:
Practice Address - City:KULPMONT
Practice Address - State:PA
Practice Address - Zip Code:17834-1248
Practice Address - Country:US
Practice Address - Phone:570-373-1015
Practice Address - Fax:570-373-1023
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001609152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT30438Medicare UPIN
PAHE437858Medicare ID - Type Unspecified