Provider Demographics
NPI:1760486096
Name:HENDRICKS, JULIE B (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:B
Last Name:HENDRICKS
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 1:724 ST. LOUIS ROAD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-2032
Mailing Address - Country:US
Mailing Address - Phone:618-345-0210
Mailing Address - Fax:618-345-4770
Practice Address - Street 1:724 ST. LOUIS ROAD
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-2032
Practice Address - Country:US
Practice Address - Phone:618-345-0210
Practice Address - Fax:618-345-4770
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008333152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046008333Medicaid
IL046008333Medicaid