Provider Demographics
NPI:1699866145
Name:HENDRIX, JASON L (OD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:L
Last Name:HENDRIX
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8262 MARKET ST STE 103
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9681
Mailing Address - Country:US
Mailing Address - Phone:910-686-3396
Mailing Address - Fax:910-686-3397
Practice Address - Street 1:8262 MARKET ST STE 103
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9681
Practice Address - Country:US
Practice Address - Phone:910-686-3396
Practice Address - Fax:910-686-3397
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1904152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093RUMedicaid
NC2473121Medicare ID - Type Unspecified
NC89093RUMedicaid