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General NPI Number Information
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NPI Number | 1164583084
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Entity Type | Individual
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Provider Name | SEAN DAVID HENDRICKS M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 2020 W ILES AVE
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4174
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Country | US
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Telephone | 217-492-9629
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Fax | 217-698-4728
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Provider Business Mailing Address
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Address Line | 2020 W ILES AVE
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4174
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Country | US
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Telephone | 217-698-3030
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Fax | 217-698-4728
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 026330
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 42382
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 20248
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 026330
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License Number State | LA
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