Provider Demographics
NPI:1154734929
Name:HENRICH, JENNA (OD)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:HENRICH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 1ST ST W
Mailing Address - Street 2:P.O. BOX 737
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-2316
Mailing Address - Country:US
Mailing Address - Phone:319-334-6087
Mailing Address - Fax:319-334-6488
Practice Address - Street 1:1310 1ST ST W
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-2316
Practice Address - Country:US
Practice Address - Phone:319-334-6087
Practice Address - Fax:319-334-6488
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073497152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy