Provider Demographics
NPI:1568528321
Name:HENDRIX, RALPH M JR (OD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:M
Last Name:HENDRIX
Suffix:JR
Gender:M
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:PO BOX 631
Mailing Address - Street 2:
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377-0631
Mailing Address - Country:US
Mailing Address - Phone:910-843-4941
Mailing Address - Fax:910-843-4872
Practice Address - Street 1:HIGHWAY 211 EAST
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377
Practice Address - Country:US
Practice Address - Phone:910-843-4941
Practice Address - Fax:910-843-4872
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC410038305OtherRAILROAD MEDICARE
NCFH7000050OtherFIRST CAROLINA CARE
NC5809354OtherAETNA
NC9369OtherBCBS
NCC6122OtherMEDCOST
NC8906369Medicaid
NC9369OtherBCBS
NCC6122OtherMEDCOST
NC246024BMedicare PIN
NC561935396OtherTAX ID NUMBER