Individual
SEAN DAVID HENDRICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2020 W ILES AVE, SPRINGFIELD, IL 62704-4174
(217) 492-9629
(217) 698-4728
Mailing address
2020 W ILES AVE, SPRINGFIELD, IL 62704-4174
(217) 698-3030
(217) 698-4728
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
026330
LA
207W00000X
Ophthalmology Physician
20248
MS
207W00000X
Ophthalmology Physician
42382
TN
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
026330
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00226767
—
MS
01
—
026330
LICENSE
LA
01
—
302I182564
MEDICARE PTAN
MS
Enumeration date
12/13/2006
Last updated
12/04/2025
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