Individual
TERRY LANE HENDRICKSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
403 N GARDEN ST, COLUMBIA, TN 38401-2903
(931) 380-2020
(931) 381-5411
Mailing address
403 N GARDEN ST, COLUMBIA, TN 38401-2903
(931) 380-2020
(931) 381-5411
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD-825-T
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0243890001
PALMETTO
TN
01
—
2001416
BLUE CROSS
TN
05
—
2001416
—
TN
Enumeration date
10/31/2005
Last updated
07/08/2007
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