Provider Demographics
NPI:1760189476
Name:HERENDEEN, EMILY (OD)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:HERENDEEN
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 1:123 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-1301
Mailing Address - Country:US
Mailing Address - Phone:269-673-5100
Mailing Address - Fax:269-673-1806
Practice Address - Street 1:123 LOCUST ST
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1301
Practice Address - Country:US
Practice Address - Phone:269-673-5100
Practice Address - Fax:269-673-1806
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005660152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist