Individual
MARILYN MARIE HENDRICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20242 STICK ROSS MOUNTAIN RD, TAHLEQUAH, OK 74464-7374
(918) 456-1133
(918) 456-1133
Mailing address
20242 STICK ROSS MOUNTAIN RD, TAHLEQUAH, OK 74464-7374
(918) 456-1133
(918) 456-1133
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
NO LICENSE REQUIRED
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
73146984401
—
OK
Enumeration date
03/22/2007
Last updated
07/09/2007
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