Provider Demographics
NPI:1154510824
Name:BARRY S. HERNDON, O.D., INC.
Entity Type:Organization
Organization Name:BARRY S. HERNDON, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-509-2225
Mailing Address - Street 1:5248 FAYE CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-7218
Mailing Address - Country:US
Mailing Address - Phone:317-509-2225
Mailing Address - Fax:317-570-2260
Practice Address - Street 1:5248 FAYE CT
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-7218
Practice Address - Country:US
Practice Address - Phone:317-509-2225
Practice Address - Fax:317-570-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001707A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty