Healthcare Provider Details

I. General information

NPI: 1891920187
Provider Name (Legal Business Name): GOMESINDO E. HENDRICKS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 E LAKE MEAD PKWY
HENDERSON NV
89015-5531
US

IV. Provider business mailing address

61 E LAKE MEAD PKWY
HENDERSON NV
89015-5531
US

V. Phone/Fax

Practice location:
  • Phone: 702-565-0555
  • Fax: 702-564-6060
Mailing address:
  • Phone: 702-565-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNV0196
License Number StateNV

VIII. Authorized Official

Name: DR. GOMESINDO E HENDRICKS
Title or Position: OWNER
Credential: O.D
Phone: 702-565-0555