Provider Demographics
NPI:1215114137
Name:JAMES P. HENNINGER
Entity type:Organization
Organization Name:JAMES P. HENNINGER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:HENNINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:570-339-2300
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 1:50 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-1300
Practice Address - Country:US
Practice Address - Phone:570-339-2300
Practice Address - Fax:570-339-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEGOO1609332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0263300001Medicare NSC