NPIMap

Individual provider Active NPI

John Perry Hendrix, O.D.

  • Optometrist
  • Statesboro, GA
National Provider Identifier
1558339135
Registry record updated May 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
GA-OPT000856 Issued in GA
Practice address
730 Northside Dr E
Statesboro, GA 30458-4766
Phone
(912) 764-7352
Fax
(912) 681-8333
NPI assigned
Mar 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 920-OD WV
Optometrist 152W00000X GA-OPT000856 GA Primary

Addresses

Primary practice location

730 Northside Dr E
Statesboro, GA 30458-4766

Mailing address

PO Box 100
Demorest, GA 30535
Phone (304) 887-2535

Other identifiers 3

IdentifierTypeStateIssuer
0150605001MedicaidWV
0150072000MedicaidWV
010049211MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
920WVMDClinical Psychologist
GA-OPT000856GAMDOptometrist
920-ODWVMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Donald K Taylor Optometrist Past Accepting new patients
Dr. Donald K Taylor Optometrist Past Accepting new patients
Dr. Donald K Taylor Optometrist Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430784000000",
    "number": "1558339135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100",
            "city": "DEMOREST",
            "state": "GA",
            "postal_code": "30535",
            "telephone_number": "304-887-2535",
            "fax_number": "912-681-8333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 NORTHSIDE DR E",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304584766",
            "telephone_number": "912-764-7352",
            "fax_number": "912-681-8333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRIX",
        "first_name": "JOHN",
        "middle_name": "PERRY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2015-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WV",
            "license": "920-OD",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "GA-OPT000856",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0150605001",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0150072000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010049211",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.