Jeffrey R Henline, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046007713 Issued in IL

Practice address

400 NE Saint Mark CT
Peoria, IL 61603-3717

Phone

(309) 674-1234

Fax

(309) 674-6422

NPI assigned

Aug 30, 2005

Last updated

Jun 18, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jeffrey.henline.p1@direct.bondeye.nextgenshare.com

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

• Vep Il Optometric LLC

  • Optometrist
  • Bloomington, IL
  • NPI 1528536620
  Medicare reassignment NPD
• Bond Eye Associates, SC

  • Ophthalmology Physician
  • Pekin, IL
  • NPI 1285725903
  Medicare reassignment
• Oneopto Il 2 PLLC

  dba All About Eyes

  • Optometrist
  • Bloomington, IL
  • NPI 1003788431
  NPD
• Bond Eye Associates, S.C.

  • Optician
  • Canton, IL
  • NPI 1104025485
  NPD (past)
• Heyde Eye Center S.C

  • Ophthalmology Physician
  • Peoria, IL
  • NPI 1205829389

  Optometrist

  NPD (past)

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276819200000",
    "number": "1275526790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 NE SAINT MARK CT",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033717",
            "telephone_number": "309-674-1234",
            "fax_number": "309-674-6422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 NE SAINT MARK CT",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033717",
            "telephone_number": "309-674-1234",
            "fax_number": "309-674-6422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENLINE",
        "first_name": "JEFFREY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-30",
        "last_updated": "2010-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046007713",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046007713",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Marie Hendricks, APN
• Samuel Hendricks, DC
• David K Hendricksen, M.D.
• Jamie Hendrickson, MS, RDN, LDN
• Mena Henien, MD
• Jesse Lee Henneberg, APN
• Kevin M Henry, MD
• Robin Dawn Henry, RN
• Elizabeth Hensold
• Grace Elizabeth Hensold, RDN, LDN

• Optometrist in Peoria, IL
• Providers in Peoria, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.