Provider Demographics
NPI:1730174079
Name:HENDRICK, JOANNE (OD)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:
Last Name:HENDRICK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 CHAPEL HILLS DR
Mailing Address - Street 2:STE 103
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1022
Mailing Address - Country:US
Mailing Address - Phone:719-599-5083
Mailing Address - Fax:719-599-3291
Practice Address - Street 1:595 CHAPEL HILLS DR
Practice Address - Street 2:SUITE 103
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1022
Practice Address - Country:US
Practice Address - Phone:719-599-5083
Practice Address - Fax:719-599-3291
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1091152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08010910Medicaid
COT60831Medicare UPIN
CO08010910Medicaid