Provider Demographics
NPI:1871738880
Name:DR POLLY HENDRICKS & ASSOCIATES, LLC
Entity type:Organization
Organization Name:DR POLLY HENDRICKS & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-288-8566
Mailing Address - Street 1:161 LEXINGTON GREEN CIR STE B6
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3323
Mailing Address - Country:US
Mailing Address - Phone:859-271-6194
Mailing Address - Fax:859-271-4399
Practice Address - Street 1:161 LEXINGTON GREEN CIR STE B6
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3323
Practice Address - Country:US
Practice Address - Phone:859-271-6194
Practice Address - Fax:859-271-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1502DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty