DR. MATTHEW THOMAS HENDRICKS (NPI# 1104391325) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104391325 |
| Entity Type | Individual |
| Full Name | DR. MATTHEW THOMAS HENDRICKS |
| Credential | O.D. |
| Practice Address |
13195 Weaver Lake Rd Maple Grove MN 55369 |
| Mailing Address |
901 Xenia Ave S Apt 623 Golden Valley MN 55416-1178 |
| Practice Telephone | 7634160622 |
| Practice Fax Number | 7634206957 |
| Mailing Telephone | 9165333942 |
| Enumeration Date | 2018-10-04 |
| Last Update Date | 2020-03-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 152W00000X | Optometrist | 3656 | MN | Eye and Vision Services Providers |
| Y | 152W00000X | Optometrist | 34118TLG | CA | Eye and Vision Services Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2404 Harbor Blvd Apt 202, Costa Mesa, CA 926266212 | 9165333942 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053974113 | Matthew C Hendricks | Chiropractor | 151 S Main Ste 4, Cedar Springs, MI 49319-8950 | 2019-04-15 |
| 1033684873 | Matthew Hendricks | Dermatology | 3 Sw 129th Ave Ste 100, Pembroke Pines, FL 33027-1778 | 2018-10-08 |
| 1821638404 | Matthew Brian Hendricks | Nurse Practitioner | 117 Commons Way, Greenville, SC 29611-3850 | 2020-01-10 |
| 1295115939 | Matthew Hendricks | Chiropractor | 4926 42nd Ave N, Robbinsdale, MN 55422-1731 | 2015-06-08 |
| 1346662830 | Matthew James Hendricks | Specialist/Technologist | 1700 W Stout St, Rice Lake, WI 54868-5000 | 2014-01-17 |
| Street Address |
13195 WEAVER LAKE RD |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55369 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215091749 | Mark Korthals | Optometrist | 13195 Weaver Lake Rd, Maple Grove, MN 55369-9410 | 2006-12-20 |
| 1548753122 | Samantha Ziegler | Optometrist | 13195 Weaver Lake Rd, Maple Grove, MN 55369-9410 | 2018-06-08 |
| 1760830012 | Rachel Naomi Knutson | Optometrist | 13195 Weaver Lake Rd, Maple Grove, MN 55369 | 2016-05-26 |
| 1659728756 | John Mueller | Optometrist | 13195 Weaver Lake Rd, Maple Grove, MN 55369-9410 | 2016-05-18 |
| 1922347848 | Jayden2006 | Technician/Technologist | 13195 Weaver Lake Rd, Maple Grove, MN 55369-9410 | 2013-02-13 |
| 1831453455 | Brandon Bruce Larson | Optometrist | 13195 Weaver Lake Rd, Maple Grove, MN 55369 | 2012-06-28 |
| 1053540690 | Kelly Crenna | Optometrist | 13195 Weaver Lake Rd, Maple Grove, MN 55369-9410 | 2009-07-03 |
| 1346453735 | Brokea Inc. | Optometrist | 13195 Weaver Lake Rd, Maple Grove, MN 55369-9410 | 2007-05-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144188 | Bonnie Rose Theis | Counselor | 24 3rd Ave Ne, Unit B, Osseo, MN 55369 | 2020-11-06 |
| 1356976328 | Kirollos Samir Hanna | Pharmacist | 14500 99th Ave N, Suite 0a030, Maple Grove, MN 55369 | 2020-03-10 |
| 1396395463 | Susan Osborne | Technician | 9240 Orchid Lane, Maple Grove, MN 55369 | 2019-09-19 |
| 1710537196 | Janis Langsdale | Technician | 11070 108 Avenue North, Maple Grove, MN 55369 | 2019-09-17 |
| 1043724552 | Tracey Wahlquist | Speech-Language Pathologist | 11100 86th Ave N, Maple Grove, MN 55369 | 2017-11-20 |
| 1154860005 | Kayla Uptagrafft | Specialist/Technologist | 9555 Upland Lane Norh, Maple Grove, MN 55369 | 2017-02-13 |
| 1750823324 | Jennifer Ranallo | Social Worker | 9600 Upland Ln N Ste 110, Maple Grove, MN 55369 | 2016-11-13 |
| 1558723999 | Debra Grace Boersma | Advanced Practice Midwife | 9825 Hospital Dr#205, Maple Grove, MN 55369 | 2016-03-24 |
| 1396129433 | Maple Grove Smiles Dentistry, PC | Dentist | 12775 Elm Creek Blvd N, Maple Grove, MN 55369 | 2015-07-18 |
| 1558755900 | Krista Newman | Counselor | 24 3rd St Nw, Unit B, Osseo, MN 55369 | 2015-03-24 |
| Find all providers in zip 55369 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265924088 | Emily Boss | Optometrist | 7767 Elm Creek Blvd N Ste 140, Maple Grove, MN 55369-7066 | 2018-06-06 |
| 1609397116 | Chuatong Thao | Optometrist | 11651 Fountains Dr Ste A-104, Maple Grove, MN 55369-7195 | 2017-07-06 |
| 1720535263 | Fischer Vision PC | Optometrist | 13334 Bass Lake Road North, Maple Grove, MN 55311 | 2016-09-01 |
| 1164861357 | Optometric Eye Care Centers, Pa | Optometrist | 7880 Main St N, Maple Grove, MN 55369-7081 | 2013-06-20 |
| 1497057871 | North Star Eye Associates | Optometrist | 7767 Elm Creek Blvd N, Ste 140, Maple Grove, MN 55369-7041 | 2010-11-17 |
| 1659556264 | G.r. Thomas Jr Od Pa | Optometrist | 7880 Mainstreet, Maple Grove, MN 55369-7081 | 2008-01-02 |
| 1942401039 | Londa Lea Fischer Costello | Optometrist | 13334 Bass Lake Rd, Maple Grove, MN 55311-4540 | 2007-05-29 |
| 1245374115 | Michael V Dieter | Optometrist | 12000 Elm Creek Blvd N Ste L90, Maple Grove, MN 55369-7168 | 2007-02-16 |
| 1396896155 | Daniel Lee Whited | Optometrist | 12131 Elm Creek Blvd N, Maple Grove, MN 55369-7093 | 2007-01-16 |
| 1063561066 | Renee M Ritzer | Optometrist | 13195 Weaver Lake Road, Maple Grove, MN 55369 | 2007-01-09 |
| Find all providers in MAPLE GROVE | ||||
| City | MAPLE GROVE |
| Zip Code | 55369 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.