Provider Demographics
NPI:1497836035
Name:HENTHORN, JAMES RICHARD (BCO BADO)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RICHARD
Last Name:HENTHORN
Suffix:
Gender:M
Credentials:BCO BADO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 S HILLSIDE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-3002
Mailing Address - Country:US
Mailing Address - Phone:316-688-5235
Mailing Address - Fax:316-651-0775
Practice Address - Street 1:744 S HILLSIDE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-3002
Practice Address - Country:US
Practice Address - Phone:316-688-5235
Practice Address - Fax:316-651-0775
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1933222OtherFDA
KS100218340AMedicaid
KS100218340AMedicaid