Hennen, Mark
Hennen, Mark is an individual health care provider with primary practice located at 1540 Humboldt Ave , Saint Paul MN 55118-3417. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Hennen, Mark can be contacted via phone (651) 457-2020.Contact Information
Primary practice address
1540 Humboldt Ave
Saint Paul MN 55118-3417
Phone: (651) 457-2020
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 1944 | Minnesota |
Profile Details
| NPI number | 1215934559 |
|---|---|
| LBN Legal business name | Hennen, Mark |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 1st, 2005 |
| Last updated | Jul 29th, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1215934559 | NPPES |
| Minnesota | MEDICAID | 237223100 |
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