Provider Demographics
NPI:1386844819
Name:HENDERSON, TRENT CHANDLER (OD)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:CHANDLER
Last Name:HENDERSON
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 1:18122 W 119TH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-9532
Mailing Address - Country:US
Mailing Address - Phone:913-261-8327
Mailing Address - Fax:913-261-8328
Practice Address - Street 1:18122 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-9532
Practice Address - Country:US
Practice Address - Phone:913-261-8327
Practice Address - Fax:913-261-8328
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA1158001Medicare PIN