Individual
DR. JEFFREY R HENLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
400 NE SAINT MARK CT, PEORIA, IL 61603-3717
(309) 674-1234
(309) 674-6422
Mailing address
400 NE SAINT MARK CT, PEORIA, IL 61603-3717
(309) 674-1234
(309) 674-6422
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046007713
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046007713
—
IL
Enumeration date
08/30/2005
Last updated
06/18/2010
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