Provider Demographics
NPI:1669513677
Name:HENDRIX, AMANDA B (OD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:B
Last Name:HENDRIX
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 1:515 JOHN S MOSBY DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-7150
Mailing Address - Country:US
Mailing Address - Phone:910-617-2466
Mailing Address - Fax:
Practice Address - Street 1:1031 GRANDIFLORA DR
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-7453
Practice Address - Country:US
Practice Address - Phone:910-371-0540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1935152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist