Provider Demographics
NPI:1083709489
Name:HENDLEY, DONALD JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JAMES
Last Name:HENDLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7745 DALEFORD DRIVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8407
Mailing Address - Country:US
Mailing Address - Phone:440-255-2194
Mailing Address - Fax:
Practice Address - Street 1:9303 MENTOR AVENUE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8407
Practice Address - Country:US
Practice Address - Phone:440-974-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3803/T1081152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH06851560HMedicaid
OHT48752Medicare UPIN
OH06851560HMedicaid