Individual
JACK T HEDRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
600 S MAIN ST, SALEM, IN 47167-1040
(812) 883-2700
(812) 883-2752
Mailing address
600 S MAIN ST, SALEM, IN 47167-1040
(812) 883-2700
(812) 883-2752
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001316A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000350877
ANTHEM BCBS
IN
05
—
100279520
—
IN
01
—
18001316A
OD LICENSE NUMBER
IN
Enumeration date
08/16/2005
Last updated
10/01/2008
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