Provider Demographics
NPI:1518513613
Name:HENDRIX EYE CLINIC, LLC
Entity Type:Organization
Organization Name:HENDRIX EYE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:HENDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-969-2565
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-0100
Mailing Address - Country:US
Mailing Address - Phone:706-969-2565
Mailing Address - Fax:706-778-0082
Practice Address - Street 1:864 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-5534
Practice Address - Country:US
Practice Address - Phone:706-778-0101
Practice Address - Fax:706-778-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier