Active NPI
Donald Wade Henderson, OD
- Optometrist
- Springfield, IL
National Provider Identifier
1578624573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046-009151
- Practice address
- 2709 S Koke Mill Rd
Springfield, IL 62711 - Phone
- (217) 698-9477
- Fax
- (217) 698-9474
- NPI assigned
- Dec 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046-009151 | IL | Primary |
Addresses
Primary practice location
2709 S Koke Mill Rd
Springfield, IL 62711
Mailing address
2709 S Koke Mill Rd
Springfield, IL 62711-8194
Phone (217) 698-9477
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Other, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2709 S Koke Mill Rd
Springfield, IL 62711-8194
Phone (217) 698-9477
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.83 of 100
- Quality
- 87.66
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 58 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1480 | KS | MD | Registered Dietitian |
| 046-009151 | IL | MD | Optometrist |
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.
-
- Optometrist
- Springfield, IL
- NPI 1295802981
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759276800000",
"number": "1578624573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2709 S KOKE MILL RD",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627118194",
"telephone_number": "217-698-9477",
"fax_number": "217-698-9474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2709 S KOKE MILL RD",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "62711",
"telephone_number": "217-698-9477",
"fax_number": "217-698-9474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "DONALD",
"middle_name": "WADE",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-13",
"last_updated": "2025-10-01",
"certification_date": "2025-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046-009151",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.