Individual provider Active NPI

Danielle Henderson

  • Optometrist
  • Hudson, WI
National Provider Identifier
1093505695
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4080-35 Issued in WI
Practice address
2215 Vine St Ste E
Hudson, WI 54016-5862
Phone
(715) 381-1234
NPI assigned
May 8, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4080-35 WI Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

2215 Vine St Ste E
Hudson, WI 54016-5862

Mailing address

2215 Vine St Ste E
Hudson, WI 54016-5862

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250905002026 WI Practitioner - Optometry 2961904214 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aeg Wisconsin Professional LTDGroup PAC ID 1557372968, 16 clinicians

Practice addresses (Care Compare)

2215 Vine St
Suite E
Hudson, WI 54016-5862
Phone (715) 381-1234

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Aeg Wisconsin Professional LTD Optometrist CurrentSince Jul 13, 2025 Accepting new patients

Locations

111 E 4th St
Ste 440
Alton, IL 62002

2215 Vine St
Ste E
Hudson, WI 54016
Phone (715) 381-1234

2215 Vine St
Hudson, WI 54016
Phone (715) 381-1110

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1746662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751846400000",
    "number": "1093505695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 VINE ST STE E",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540165862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 VINE ST STE E",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540165862",
            "telephone_number": "715-381-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "DANIELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-08",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "4080-35",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hudson, WI

Sources for this page

Verify at the official NPI Registry.