Healthcare Provider Details

I. General information

NPI: 1568528321
Provider Name (Legal Business Name): RALPH M HENDRIX JR. OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 211 EAST
RED SPRINGS NC
28377
US

IV. Provider business mailing address

PO BOX 631
RED SPRINGS NC
28377-0631
US

V. Phone/Fax

Practice location:
  • Phone: 910-843-4941
  • Fax: 910-843-4872
Mailing address:
  • Phone: 910-843-4941
  • Fax: 910-843-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number864
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: