Provider Demographics
NPI:1225386659
Name:HENKER, DON C H (OD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:C H
Last Name:HENKER
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 1:1333 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1734
Mailing Address - Country:US
Mailing Address - Phone:208-265-4140
Mailing Address - Fax:208-265-4448
Practice Address - Street 1:1333 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1734
Practice Address - Country:US
Practice Address - Phone:208-265-4140
Practice Address - Fax:208-265-4448
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP100252152W00000X
WAOD 00003201152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist