Provider Demographics
NPI:1013131648
Name:HENDRIX OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:HENDRIX OPTOMETRIC CORPORATION
Other - Org Name:EYEWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-882-4809
Mailing Address - Street 1:223 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1208
Mailing Address - Country:US
Mailing Address - Phone:812-882-4809
Mailing Address - Fax:812-882-9485
Practice Address - Street 1:223 MAIN ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1208
Practice Address - Country:US
Practice Address - Phone:812-882-4809
Practice Address - Fax:812-882-9485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN56000051A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN258660OtherMEDICARE GROUP
IN100319410AMedicaid
IN=========OtherEIN
IN=========OtherEIN