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General NPI Number Information
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NPI Number | 1871780627
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Entity Type | Organization
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Legal Business Name | KATHY HENDRICKSON, O.D., P.C.
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 110 9TH AVE S
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City | CARRINGTON
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State | ND
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Zip | 58421-2020
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Country | US
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Telephone | 701-652-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 110 9TH AVE S P.O. BOX 220
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City | CARRINGTON
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State | ND
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Zip | 58421-2020
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Country | US
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Telephone | 701-652-2020
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | KATHY MARIE HENDRICKSON
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Credential | O.D.
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Telephone | 701-652-2020
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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 | 578
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License Number State | ND
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