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1619069671 NPI number — RONALD ALAN HENSEN O.D.

NPI Number: 1619069671
Health Care Provider/Practitioner: RONALD ALAN HENSEN O.D.

Information about “1619069671” NPI (RONALD ALAN HENSEN O.D.) exists in 1619069671 in HTML format HTML  |  1619069671 in plain Text format TXT  |  1619069671 in PDF (Portable Document Format) PDF  |  1619069671 in an XML format XML  formats.

NPI Number : 1619069671 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619069671",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HENSEN",
    "FirstName": "RONALD",
    "MiddleName": "ALAN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "O.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5385 WALNUT AVE",
    "SecondLineMailingAddress": "STE 2",
    "MailingAddressCityName": "CHINO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91710-2605",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "909-627-8523",
    "MailingAddressFaxNumber": "909-627-5183",
    "FirstLinePracticeLocationAddress": "5385 WALNUT AVE",
    "SecondLinePracticeLocationAddress": "STE 2",
    "PracticeLocationAddressCityName": "CHINO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91710-2605",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "909-627-8523",
    "PracticeLocationAddressFaxNumber": "909-627-5183",
    "EnumerationDate": "09/28/2006",
    "LastUpdateDate": "05/30/2008",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "332H00000X",
          "TaxonomyName": "Eyewear Supplier",
          "LicenseNumber": "6686",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "6686",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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