Provider Demographics
NPI:1881619633
Name:HENDERLITE, ROBERT L
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:HENDERLITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8426 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-9746
Mailing Address - Country:US
Mailing Address - Phone:704-510-9292
Mailing Address - Fax:704-510-9881
Practice Address - Street 1:8426 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 500
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-9746
Practice Address - Country:US
Practice Address - Phone:704-510-9292
Practice Address - Fax:704-510-9881
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2724Medicaid
SCDM0376Medicaid
SCDE2724Medicaid