Provider Demographics
NPI:1306025994
Name:HENNING, JUDY C (OD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:C
Last Name:HENNING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JUDY
Other - Middle Name:C
Other - Last Name:CHIANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:41200 MURRIETA HOT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9479
Mailing Address - Country:US
Mailing Address - Phone:951-461-0311
Mailing Address - Fax:
Practice Address - Street 1:41200 MURRIETA HOT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9479
Practice Address - Country:US
Practice Address - Phone:951-461-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11840T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist