MEDICARE: DR. AMANDA B HENDRIX O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	NC1935	NC

General Provider Information

NPI Number	:	1669513677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA B HENDRIX O.D.

Provider Business Mailing Address
First Line	:	515 JOHN S MOSBY DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-7150
Country	:	US
Telephone Number	:	910-617-2466
Fax Number	:

Provider Business Practice Location Address
First Line	:	1031 GRANDIFLORA DR
Second Line	:
City	:	LELAND
State	:	NC
Zip	:	28451-7453
Country	:	US
Telephone Number	:	910-371-0540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2007
Last Update Date	:	03/17/2018

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