MEDICARE: MRS. JOANNE HENDRICK OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1091	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730174079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOANNE HENDRICK OD

Provider Business Mailing Address
First Line	:	595 CHAPEL HILLS DR
Second Line	:	STE 103
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1022
Country	:	US
Telephone Number	:	719-599-5083
Fax Number	:	719-599-3291

Provider Business Practice Location Address
First Line	:	595 CHAPEL HILLS DR
Second Line	:	SUITE 103
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1022
Country	:	US
Telephone Number	:	719-599-5083
Fax Number	:	719-599-3291

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	05/11/2010

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