Provider Demographics
NPI:1619069671
Name:HENSEN, RONALD ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ALAN
Last Name:HENSEN
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 1:5385 WALNUT AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2605
Mailing Address - Country:US
Mailing Address - Phone:909-627-8523
Mailing Address - Fax:909-627-5183
Practice Address - Street 1:5385 WALNUT AVE
Practice Address - Street 2:STE 2
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2605
Practice Address - Country:US
Practice Address - Phone:909-627-8523
Practice Address - Fax:909-627-5183
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6686332H00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT-10393Medicare UPIN
CA0287820001Medicare NSC
CAYYY49545YMedicare PIN