Ronald Wayne Henson, O.D.
Individual provider Active NPI Optometrist · Delavan, WI
NPI 1508967282 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1508967282
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 1267 (WI)
- Practice address
- 1819 E Geneva St
Delavan, WI 53115-2037 - Phone
- (262) 740-7213
- Fax
- (262) 740-7226
- NPI assigned
- Sep 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1267 | WI | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1267 | WI | Yes |
Addresses
Primary practice location
1819 E Geneva St
Delavan, WI 53115-2037
Mailing address
2305 Ramshead CT
Waukesha, WI 53188-1562
Phone (262) 549-0215
Other providers in Delavan, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.