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General NPI Number Information
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NPI Number | 1083791354
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Entity Type | Organization
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Legal Business Name | HENDERSON OPTICAL, LLC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 1201 SUMMIT AVE
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City | FORT WORTH
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State | TX
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Zip | 76102-4413
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Country | US
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Telephone | 817-336-3653
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Fax | 817-332-4233
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Provider Business Mailing Address
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Address Line | 1201 SUMMIT AVE
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City | FORT WORTH
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State | TX
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Zip | 76102-4413
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Country | US
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Telephone | 817-336-3653
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Fax | 817-332-4233
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Authorized Official
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Title or Position | OPHTHALMOLOGIST
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Name | DAN BRUHL
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Credential | M.D.
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Telephone | 817-336-3653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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