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General NPI Number Information
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NPI Number | 1770559874
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Entity Type | Organization
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Legal Business Name | JAMES R HENSLICK,O.D. PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/27/2006
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Last Update Date | 11/12/2008
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Provider Practice Location Address
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Address Line | 27451 LA PAZ RD SUITE B
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-3739
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Country | US
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Telephone | 949-643-2020
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Fax | 949-643-9061
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Provider Business Mailing Address
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Address Line | 27451 LA PAZ RD SUITE B
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-3739
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Country | US
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Telephone | 949-643-2020
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Fax | 949-643-9061
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Authorized Official
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Title or Position | OFFICER - PRESIDENT
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Name | DR. JAMES ROBERT HENSLICK
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Credential | O.D.
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Telephone | 949-643-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT 9009 TPL
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License Number State | CA
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