Provider Demographics
NPI:1437214632
Name:HENSLICK, JAMES ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:HENSLICK
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 1:27451 LA PAZ RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4082
Mailing Address - Country:US
Mailing Address - Phone:949-643-2020
Mailing Address - Fax:949-643-9061
Practice Address - Street 1:27451 LA PAZ RD
Practice Address - Street 2:SUITE B
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-4082
Practice Address - Country:US
Practice Address - Phone:949-643-2020
Practice Address - Fax:949-643-9061
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 9009 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0090090Medicaid
CAU77433Medicare UPIN
CASD0090090Medicaid