Provider Demographics
NPI:1114978723
Name:HENDY, CAROLINE L (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:L
Last Name:HENDY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 W 5TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1615
Mailing Address - Country:US
Mailing Address - Phone:606-877-1101
Mailing Address - Fax:606-878-6356
Practice Address - Street 1:1370 W 5TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1615
Practice Address - Country:US
Practice Address - Phone:606-877-1101
Practice Address - Fax:606-878-6356
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1363DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000202838OtherBCBS
KY5919OtherP10
KY611344538OtherTAX ID #
KY77013639Medicaid
KY77903276Medicaid
KY1267150001OtherPALMETTO
KY000000064776OtherBCBS GROUP #
KY77013639Medicaid
KY611344538OtherTAX ID #