MEDICARE: VINCENT GASSEN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	364	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356340863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT GASSEN O.D.

Provider Business Mailing Address
First Line	:	1505 WIGWAM PKWY STE 100
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-8195
Country	:	US
Telephone Number	:	702-485-5000
Fax Number	:	702-485-5001

Provider Business Practice Location Address
First Line	:	1505 WIGWAM PKWY STE 100
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-8195
Country	:	US
Telephone Number	:	702-896-6043
Fax Number	:	702-896-9591

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	01/03/2024

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Directions to “ VINCENT GASSEN O.D.” Practice Location

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