Individual provider Active NPI

Jennifer Zee Henrikson, OD

  • Optometrist
  • Capitola, CA
National Provider Identifier
1700859378
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
11791T Issued in CA
Practice address
2121 41St Ave
#108
Capitola, CA 95010
Phone
(831) 476-7744
Fax
(831) 464-1515
NPI assigned
Feb 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 11791T CA Primary

Addresses

Primary practice location

2121 41St Ave
#108
Capitola, CA 95010

Mailing address

4150 Bain Ave
Santa Cruz, CA 95062
Phone (831) 462-4024

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11791TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Michael G Sonnleitner Optometrist Past Accepting new patients
Pearle Visioncare, Inc Past Accepting new patients
Pearle Visioncare, Inc Past Accepting new patients

Organizations & group practices 3

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": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700859378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 BAIN AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "95062",
            "telephone_number": "831-462-4024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 41ST AVE",
            "address_2": "#108",
            "city": "CAPITOLA",
            "state": "CA",
            "postal_code": "95010",
            "telephone_number": "831-476-7744",
            "fax_number": "831-464-1515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRIKSON",
        "first_name": "JENNIFER",
        "middle_name": "ZEE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11791T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Capitola, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.