Healthcare Provider Details

I. General information

NPI: 1851665996
Provider Name (Legal Business Name): MATTHEW S HENDRICKSON, OD & ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 EXECUTIVE PL STE 403
GENEVA IL
60134-2482
US

IV. Provider business mailing address

1250 EXECUTIVE PL STE 403
GENEVA IL
60134-2482
US

V. Phone/Fax

Practice location:
  • Phone: 854-458-2432
  • Fax:
Mailing address:
  • Phone: 854-458-2432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046010209
License Number StateIL

VIII. Authorized Official

Name: MATTHEW S HENDRICKSON
Title or Position: PRESIDENT
Credential: OD
Phone: 854-458-2432