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General NPI Number Information
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NPI Number | 1154510824
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Entity Type | Organization
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Legal Business Name | BARRY S. HERNDON, O.D., INC.
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 5248 FAYE CT
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City | CARMEL
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State | IN
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Zip | 46033-7218
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Country | US
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Telephone | 317-509-2225
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Fax | 317-570-2260
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Provider Business Mailing Address
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Address Line | 5248 FAYE CT
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City | CARMEL
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State | IN
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Zip | 46033-7218
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Country | US
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Telephone | 317-509-2225
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Fax | 317-570-2260
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Authorized Official
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Title or Position | PRESIDENT
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Name | BARRY S HERNDON
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Credential | O.D.
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Telephone | 317-509-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18001707A
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License Number State | IN
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