Provider Demographics
NPI:1710971650
Name:HENBEST, JENNIFER LEIGH (OD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEIGH
Last Name:HENBEST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEIGH
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3200 S AIRPORT RD W
Mailing Address - Street 2:TRAVERSE CITY
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-8117
Mailing Address - Country:US
Mailing Address - Phone:231-929-7711
Mailing Address - Fax:231-929-7768
Practice Address - Street 1:3200 S AIRPORT RD W
Practice Address - Street 2:TRAVERSE CITY
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-8117
Practice Address - Country:US
Practice Address - Phone:231-929-7711
Practice Address - Fax:231-929-7768
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004192152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN89470001Medicare ID - Type Unspecified
N34040110Medicare PIN
MIN26930208Medicare PIN
MIN26930112Medicare PIN
MIU99738Medicare UPIN