Provider Demographics
NPI:1669436564
Name:HENDRIX, MARK CHARLES (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHARLES
Last Name:HENDRIX
Suffix:
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 1:1922 MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-5929
Mailing Address - Country:US
Mailing Address - Phone:812-882-1211
Mailing Address - Fax:
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
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ1843B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN622531OtherTRIGON
IN0327640001OtherDMERC
IN351433409050OtherCARESOURCE/MEDICAID
IN000000083975OtherBLUE CROSS
INT34821Medicare UPIN
IN197070Medicare UPIN
IN351433409050OtherCARESOURCE/MEDICAID