Basic Information
| Provider Information | |||||||||
| NPI: | 1669513677 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENDRIX | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 JOHN S MOSBY DR | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284127150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106172466 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1031 GRANDIFLORA DR | ||||||||
| Address2: | |||||||||
| City: | LELAND | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284517453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103710540 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | NC1935 | NC | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.